Life Claims Consultant

Summary:

The Life Claims Consultant is responsible for assessing and making decisions on life insurance claims, including high-value and suspicious cases, ensuring compliance with a $5M signature authority limit. This role involves analyzing various documents such as death certificates, claim forms, legal documentation, and conducting routine reviews of contestable claims in accordance with contract language and state laws. You'll provide direction on complex claim referrals, collaborating with various departments such as Law, Underwriting, and Special Investigations. You must clearly communicate claims decisions and handle disputes or appeals on complex claims, collaborating with legal counsel and participate in depositions as necessary.

Primary Duties & Responsibilities:

Decision Making and Claims Review

• Preserve Northwestern Mutual's image and reputation in making benefit decisions despite difficult and emotional circumstances.
• Make fair, accurate, and timely decisions on life insurance claims, involving high value policies, suspicious circumstances, and/or newly issued policies within the contestable period, all while maintaining compliance with a $5M signature authority limit.
• Examine and analyze claim information, including beneficiary data, policy values, death certificates, claim forms, assignment forms, divorce decrees, and estate and trust documentation, and other relevant documents.
• Conduct routine contestable claim reviewsin accordance with applicable contract language and state laws. Frequently review medical records, pharmacy reports, police reports, medical examiner reports, policy applications, and underwriting assessments.
• Communicate claims decisionsto beneficiaries and other parties clearly and sensitively, providing detailed explanations and supporting documentation as needed, often in written form.
• Manage and resolve disputes or appeals related to claims decisions with legal counsel and be prepared to represent the company in legal matters, including depositions and trials.
• Exhibit empathy, professionalism, and tactin all interactions, especially with sensitive or contentious claims.
• Manage phone and transactional responsibilities with a strong commitment to confidentiality.
• Maintain organization, accuracy, and timelinessin case management systems; accurately capture and document claim-related information and/or refer tasks as appropriate.
• Ensure efficiency and accuracy by maintaining production and claim quality standards.
• Facilitate internal and external claim auditsas necessary.

Leadership and Collaboration

• Provide direction on claim referralswithin the division by sharing knowledge and expertise on complex claim situations that may arise within the scope of the role.
• Collaborate on complex claimswith partners in Law, Underwriting, Special Investigations Unit, Reinsurance Administration, Disability Claims, Long-Term Care Claims, Treasury, and Field Client Services.
• Participate in continuous improvement initiativesto enhance claims processes, reduce turnaround times, and improve accuracy.
• Assist with special projects to support the business.
• Embrace and advocate for new technology, educating beneficiaries and field representatives.
• Support digital capabilitiesand adapt positively to changing environments and new situations.

Qualifications:

• Bachelor's degree or equivalent combination of education and progressively responsible work experience.
• Experience in claims, underwriting, healthcare, or investigative work is preferred.
• Minimum 4 years management level experience working in insurance operations or a related field.
• High degree of accuracy in handling detailed technical work.
• Self-motivated with proven responsibility for work results and group goals.
• Technically savvy with the ability to toggle between multiple applications and monitors simultaneously.
• Strong organizational skills, able to independently prioritize to meet deadlines.
• Excellent communication skills (both verbal and written) to include the proven ability to negotiate.
• Leadership and decision-making skills, to include the abilities to evaluate/identify, diagnose and implement decisions/solutions to questions/problems within the scope of the job.
• Ability to analyzing complex information and ask thoughtful questions.

Desired Skills:

• Adaptive Communication (Advanced)
• Attention to Detail (Advanced)
• Decision Making (Advanced)
• Analytical Thinking (Advanced)
• Empathetic Communication (Advanced)
• Prioritization (Advanced)
• Problem Management (Advanced)
• Claims Acumen (Advanced)
• Medical Terminology (Intermediate)

This position has been classified as an Associated Person under NMIS guidelines and requires fingerprinting and completion of required form.

Required Certifications:

Northwestern Mutual pays on a geographic-specific salary structure and placement in the salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity as well as the cost of labor in the market; and other conditions of employment. At Northwestern Mutual, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. Please note that the salary range listed in the posting is the standard pay structure. Positions in certain locations (such as California) may provide an increase on the standard pay structure based on the location. Please click here for additional information relating to location-based pay structures.

We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, disability, age or status as a protected veteran, or any other characteristic protected by law.

If you work or would be working in California, Colorado, New York City, Washington or outside of a Corporate location, please click here for information pertaining to compensation and benefits.

We're excited about the potential people bring to Northwestern Mutual. You can grow your career here while enjoying first-class perks, benefits, and commitment to diversity and inclusion.

• Flexible work schedules
• Concierge service
• Comprehensive benefits
• Employee resource groups