Claims Executive

Executives

• Claims Background, Process Life Insurance Claim request with Insurance Regulations
• Reviewing & Indexing documents to determine type of request(s) and process them as per set guidelines
• Review & Investigating Claims
• Determines covered insurance losses by studying provisions of a policy or certificate.
• Establishes proof of loss by studying documentation and assembling additional information from outside sources
• Documents specific claims by completing and recording forms, reports, logs, and records.
• Resolves claims by approving or denying documentation, calculating benefits due, and determining compensation settlement.
• Ensures legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
• Maintains quality customer service by following customer services practices and responding to customer inquiries
• Provides legal support by assembling documentation for settlement action.
• Maintains a good relationship with insurance departments.
• Protects operations by keeping claims information confidential.
• Processing transactions received through faxes, web submissions, mail, Contact Center requests, etc.
• Processing a wide range of non-financial transactions through good order review for incoming contract changes due to death claim or divorce transactions.
• Knowledge and proficiency of multiple mainframe systems necessary.
• Researching in automated work distributor for duplicate work items, routing, as necessary.
• Redirect documents to appropriate operational area as needed
• Contribute to individual quality and productivity goals by meeting processing targets focused on turnaround time expectations
• Promote a positive customer service mindset to surpass the expectations of customers through continuous improvement
• Identify and capitalize on best practices to ensure consistency and optimal performance in a team based environment
• Active participation in ongoing development of self
• Continue to build additional knowledge and understanding of the client’s business
• Perform other duties as needed