Claims Specialist

What You Can Expect In This Role

Request and review claims requirements in order to determine coverage and finalize settlement of policy/contract benefits as they are payable in accordance with policy provisions, state and federal legislation and company stated compliance and business requirements. Responsible to complete the follow up on outstanding claim requirements with Agents, Policy Holders, Beneficiaries and Attorneys using professional verbal and written communication skills. Adhere to various legislation or settlement agreement requirements related to the handling of Claims.

• Request and follow up for all outstanding claim requirements needed in finalizing the settlement of policy/contract benefits as they are payable.
• Determine all requirements are met to company, state and regulatory standards before completing the payment of policy/contract benefits payable.
• Ensure that all policy/contract settlements are completed within the Service Level and Quality Standard Agreements.
• Review and complete the review of data to meet all service level requirements in audits and settlement agreements.
• Request and gather medical records, legal documents, duplicate policies, etc. to assist in review for determining coverage in accordance with the policy/contract and rider provisions.
• Apply department standards to elevate complex claim or benefit related requests to the Manager and/or Legal Department.
• Correspond in writing and communicate via telephone to assist internal and external customers with questions. Phone call handling for all Claims related calls in a professional and customer centric manner. Calls must be handled according to company policy and procedure and Service Level and Quality Standard Agreements.
• Review and complete all Benefit processing requests as needed according to Service Level and Quality Standard Agreements.
• Support the initial notification process as needed by researching and reviewing the policy/contract data file and using industry standard tools to determine coverage under the policy provisions and to whom the policy benefits are payable.
• Correspond in writing and communicate via telephone to assist agents, beneficiaries, attorneys, and contract/policy owners.
• Participate in and complete all monthly balancing of department accounts as needed including suspense accounts utilizing the open items suspense reports and reconciliations.
• Follow all procedures to ensure all controls are being maintained properly.
• Follow up on pending claim files every 30 days in writing, or per state regulations.
• Correspond in writing and communicate via telephone to assist internal and external customers with questions regarding various audits, NCOIL legislation and Settlement Agreements.
• Acquire and maintain a working knowledge of company products as they pertain to the Claims Department. This includes staying familiar with the most up to date changes to procedures as well as completing any required training courses as assigned.
• Acquire and maintain basic system, tax, procedural and compliance knowledge as it pertains to the Claims Department.
• Assist with projects that enhance productivity and system integrity as needed.
• Track and provide customer feedback via the ACT Log by listening to the voice of the customer.
• Provide feedback and opinions to your Manager that will assist in improving service and efficiencies within the department.
• Model Core values daily and display the values within your work, how you interact with others employees.
• Drive to meet/exceed all performance goals including KPIs (key performance indicators), SLAs (service level agreements) and other communicated standards.
• Proactively participate in daily huddle board discussions offering ideas, insights and support.
• Actively participate in problem solving sessions (standard work, root cause problem solving, etc.) as requested by your manager.
• Take ownership of implementing standard work and other changes into your daily work processes.
• Continuously strive to create a positive customer experience throughout all customer interactions, request processing/handling, and problem-solving efforts.
• All other duties as assigned by manager in an effort to support all Claims Department process, procedure and responsibilities.
• Commitment to embrace Sammons Financial Group Companies shared values (Accountability, Connection, Openness, Respect and Integrity).
• As stated within the Company Attendance and Punctuality policy, regular attendance is required and expected in order to meet the business service levels and workflow demands.
• Other duties as assigned.

• Bachelor's Degree Preferred
• 2-4 years' Insurance or Annuity/Life Claim experience Preferred
• Must have the ability to communicate effectively and tactfully with agents, policyholders, beneficiaries and other staff members.
• Must have knowledge of and ability to maneuver through multiple information screens
• Previous customer service experience preferred
• Must have strong organizational…