What are the responsibilities and job description for the Annuity Claims Specialist position at SILAC Insurance Company?
OVERVIEW
The Annuity Claims Specialist is responsible for handling annuity-specific death and health rider claims, ensuring accurate and timely processing while maintaining a high level of customer service. This role involves making outgoing calls to beneficiaries and claimants regarding claims-related matters and supporting the team by taking incoming calls that involve complex claim inquiries. Over time, the specialist will also be trained to process health rider requests in addition to annuity death claims.
This position focuses exclusively on annuity claims and does not involve other lines of business such as Medicare supplements, life insurance, or long-term care policies.
KEY RESPONSIBILITIES
Claims Review & Processing
- Evaluate and process death benefit claims for annuity policies, ensuring accuracy and compliance with contract terms.
- Validate required documentation and process claims in accordance with company policies and industry regulations.
- Learn and eventually handle health rider claims in conjunction with death benefit claims.
Outbound & Inbound Communication
- Conduct outgoing calls to beneficiaries and claimants to provide updates, request missing documentation, or clarify claim details.
- Respond to complex incoming inquiries from internal team members regarding claims processes, policy provisions, and contract-specific claim requirements.
- Effectively communicate claim determinations and policy guidelines in a professional and empathetic manner.
Regulatory Compliance & Product Knowledge
- Ensure all claims processing activities comply with state and federal insurance regulations and SILAC's internal policies.
- Stay up to date on annuity contract provisions, claims procedures, and health rider benefits.
- Follow standard operating procedures for claim assessments, calculations, documentation retention, and system entries.
Fraud Prevention & Risk Management
- Identify potential fraudulent claims by reviewing documentation for inconsistencies, irregularities, or red flags.
- Escalate suspicious claims for further review and investigation as needed.
Collaboration & Additional Responsibilities
- Work closely with internal teams, including Customer Experience, Compliance, and Claims leadership, to resolve claim-related issues efficiently.
- Participate in ongoing training and development to enhance claims processing expertise.
- Perform additional projects or duties as assigned by the Claims Manager.
JOB REQUIREMENTS
Required:
- Strong analytical and research skills to assess claim validity and resolve discrepancies.
- Ability to clearly communicate complex claim information in both verbal and written formats.
- Experience with mainframe computer systems or proficiency in PC applications such as MS Word, Outlook, and other business software.
- High attention to detail with strong organizational skills and accuracy in documentation review.
- Ability to manage multiple priorities and work efficiently in a fast-paced environment.
- High school diploma, GED, or equivalent experience demonstrating the ability to perform the role effectively.
Desired:
- Previous experience processing annuity death claims or other insurance claims.
- Familiarity with health rider claims processing and related annuity policy provisions.
- Basic understanding of legal statutes and regulations governing annuity claims.
OVERVIEW
The Annuity Claims Specialist is responsible for handling annuity-specific death and health rider claims, ensuring accurate and timely processing while maintaining a high level of customer service. This role involves making outgoing calls to beneficiaries and claimants regarding claims-related matters and supporting the team by taking incoming calls that involve complex claim inquiries. Over time, the specialist will also be trained to process health rider requests in addition to annuity death claims.
This position focuses exclusively on annuity claims and does not involve other lines of business such as Medicare supplements, life insurance, or long-term care policies.
KEY RESPONSIBILITIES
Claims Review & Processing
- Evaluate and process death benefit claims for annuity policies, ensuring accuracy and compliance with contract terms.
- Validate required documentation and process claims in accordance with company policies and industry regulations.
- Learn and eventually handle health rider claims in conjunction with death benefit claims.
Outbound & Inbound Communication
- Conduct outgoing calls to beneficiaries and claimants to provide updates, request missing documentation, or clarify claim details.
- Respond to complex incoming inquiries from internal team members regarding claims processes, policy provisions, and contract-specific claim requirements.
- Effectively communicate claim determinations and policy guidelines in a professional and empathetic manner.
Regulatory Compliance & Product Knowledge
- Ensure all claims processing activities comply with state and federal insurance regulations and SILAC's internal policies.
- Stay up to date on annuity contract provisions, claims procedures, and health rider benefits.
- Follow standard operating procedures for claim assessments, calculations, documentation retention, and system entries.
Fraud Prevention & Risk Management
- Identify potential fraudulent claims by reviewing documentation for inconsistencies, irregularities, or red flags.
- Escalate suspicious claims for further review and investigation as needed.
Collaboration & Additional Responsibilities
- Work closely with internal teams, including Customer Experience, Compliance, and Claims leadership, to resolve claim-related issues efficiently.
- Participate in ongoing training and development to enhance claims processing expertise.
- Perform additional projects or duties as assigned by the Claims Manager.
JOB REQUIREMENTS
Required:
- Strong analytical and research skills to assess claim validity and resolve discrepancies.
- Ability to clearly communicate complex claim information in both verbal and written formats.
- Experience with mainframe computer systems or proficiency in PC applications such as MS Word, Outlook, and other business software.
- High attention to detail with strong organizational skills and accuracy in documentation review.
- Ability to manage multiple priorities and work efficiently in a fast-paced environment.
- High school diploma, GED, or equivalent experience demonstrating the ability to perform the role effectively.
Desired:
- Previous experience processing annuity death claims or other insurance claims.
- Familiarity with health rider claims processing and related annuity policy provisions.
- Basic understanding of legal statutes and regulations governing annuity claims.
