Claims Specialist

Overview: 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. Responsibilities:

• 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 escalate 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.
  

Qualifications:

• 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 skills
• Ability to work efficiently and independently or in a team environment
• Able to adapt to frequent change, including daily transition of work duties, between tasks and lines of business.
• An appreciation for detail and problem solving skills
• Computer skills, PC, Microsoft Office
• Excellent verbal and written communication skills

Suitability Requirements:

• Criminal background check required.
• FINRA regulations require fingerprinting for this position.

Company Information: •Sammons Financial Group offers a competitive benefit package that includes: Health, Dental, Vision, Company Paid Retirement, PTO and Holiday Pay.

• Our Employee Stock Ownership Plan (ESOP) is a 100% company-funded retirement plan, so you can save for retirement without contributing a penny of your own paycheck.
• Healthy balance between work and personal lives. Friday afternoons off all year long, competitive PTO, and generous number of paid holidays.
• Our incentive program for defined goals subject to eligibility and performance. Monetary rewards are based on individual and/or overall company performance.
• Colleagues who support one another, model our core values, and drive our healthy, high-performing culture. Pay Transparency Verbiage: Range includes data points from multiple labor markets. Specific range is dependent on the labor market where the incumbent will be hired to perform the position. Starting salary is dependent on candidate qualifications and experience. For a narrower salary range specific to your labor market, please inquire. Work Authorization/Sponsorship: At this time, we’re not considering candidates that need any type of immigration sponsorship now or in the future or those needing work authorization for this role (This includes, but is not limited to students on F1-OPT, F1-CPT, J-1, etc.)