Senior Claims Administrator - EMC Life

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Requirements:

• Bachelor’s degree in insurance or business administration, or equivalent relevant experience.
• Three years of experience in life, annuity, and/or health claims.
• LOMA and/or International Claims Association certifications preferred.
• Strong knowledge of relevant claims processing, federal and state regulations.
• Good knowledge of medical and legal terminology.
• Strong skills in 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.

Responsibilities:

• Analyzes, investigates, and adjudicates life, annuity, and illness claims for timely benefits payment.
• Obtains necessary reports and medical records to process claims accurately.
• Prepares filings and tracks reinsurance benefits payments.
• Ensures claims compliance with mandates and identifies potential fraud.
• Responds to inquiries from agents, policy owners, and beneficiaries regarding claims.
• Collaborates with management for consistent policy interpretations.
• Trains new and assists current claims team members.
• Documents claims procedures and maintains the administration manual.