Senior Claims Administrator - EMC Life

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Requirements:

• Bachelor’s degree, preferably in insurance or business administration, or equivalent relevant experience.
• Three years of experience in life, annuity, and/or health claims, or related experience.
• LOMA and/or International Claims Association (ICA) certifications preferred.
• Strong knowledge of life, annuity, waiver of premium, contestable, and critical/chronic claims processing.
• Good knowledge of medical and legal terminology.
• Strong computer knowledge of Microsoft Suite, Outlook, Access, and insurance administration systems.
• Excellent verbal and written communication skills.
• Strong math and analytical skills.
• Good investigative and problem-solving abilities.
• Excellent organizational and customer service skills.
• Ability to work in a fast-paced team environment.

Responsibilities:

• Analyzes, investigates, and adjudicates individual/group life and annuity claims.
• Obtains necessary documents to process claims and prepares filings for reinsurance benefits.
• Ensures compliance with mandates and reviews claims for potential fraud.
• Responds to inquiries from agents, policyowners, and beneficiaries regarding claims.
• Processes complicated beneficiary and ownership changes after the death of the owner.
• Investigates pre-existing health information for contestability issues.
• Collaborates with peers and management on policy interpretations.
• Reports legal matters to corporate counsel and assists with complaints.
• Trains new claims team members and assists with processing issues.
• Approves waiver of premium claims and monitors disability status.
• Documents claims procedures and maintains the claims administration manual.