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Makes timely, accurate, and customer-focused life, accident, new and ongoing claim decisions using advanced independent discretion, guided by company procedures and regulatory standards
handles complex claims
obtains relevant medical, legal , employer, financial, and other information
compares the information to the terms, limitations, and conditions of the contract and applicable procedural documents, and renders the claim decision as quickly as possible
Documents the claims system in an accurate and comprehensive manner
prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome
remains in full compliance with regulatory requirements
demonstrates an above average level of proficiency in product and claims administration techniques
remains fully compliant with operational standards
meets or exceeds claims team operational metrics
Maintains a level of genuine caring and empathetic customer service throughout all interactions
takes appropriate actions to earn the claimant's and employer's trust and confidence
anticipates customer’s needs and takes action as appropriate
Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence
Mentors and coaches new team members and participates in projects supporting the team's business initiatives
Performs other related duties as required
Requirements
High School Diploma or equivalent
3 - 5 years of Life industry claims experience
Demonstrated proficiency in product specific areas of Life or Disability as well as federal and state regulations governing these products and services
Or an equivalent combination of education and experience
Strong familiarity with claim management concepts
Strong understanding of medical terminology/pathology/anatomy
Articulate verbal and writing skills, decision making, meeting deadlines, working with confidential information
Strong skills with Microsoft Office and other software applications
Ability to multi-task and prioritize
High level of attention to detail
High attention to departmental/company procedures/practices
Nice to have
Bachelor's Degree In a related field
What we offer
Medical, dental, and vision coverage
Prescription drug coverage
Health care flexible spending
Dependent care flexible spending
Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee)
401(k) plans
Annual bonuses
Opportunity to purchase company stock
11 paid holidays
Up to 20 days PTO
State-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked)