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Senior Claims Administrator
EMC Insurance CompaniesSenior Claims Administrator responsible for analyzing and processing life and disability income claims for EMC Life. Ensuring compliance and timely payment of benefits while collaborating with peers and management.
About the role
Key responsibilities & impact- Analyzes and investigates claims to ensure compliance and timely payment of benefits
- Responds to agents and policyholders regarding pending claims and appeals
- Processes complex beneficiary and ownership changes and approves eligibility of waivers for life and disability income policies
- Collaborates with peers and management to ensure consistent interpretations of policies and claim payment methods
- Obtains reports, medical records, eligibility, and/or additional information required to investigate and process claims
- Prepares filings for all life reinsurance benefits and tracks status of payments
- Ensures that claims are in compliance with state and federal mandates and reviews for red flags associated with potentially fraudulent claims
- Trains new claims team members and assists current claims staff with processing issues
- Documents claims procedures and maintains the claims administration manual as assigned by the Claims Manager
Requirements
What you’ll need- Bachelor’s degree, preferably in insurance or business administration, or equivalent relevant experience
- Three years of experience in life, annuity and/or health claims, or related experience
- LOMA and/or International Claims Association (ICA) certifications preferred
- Strong knowledge of life, annuity, WOP, contestable, and critical/chronic claims processing
- Good knowledge of medical and legal terminology
- Strong computer knowledge of Microsoft Suite, Outlook, Access, and insurance administration systems
- Excellent verbal and written communication skills
- Strong math and analytical skills
- Good investigative and problem-solving abilities
- Excellent organizational and customer service skills
- Ability to work in a fast-paced team environment
Benefits
Comp & perks- Health insurance
- 401(k) plan match
- Pension plan
- OneEMC bonus plan
- Volunteer time off annually
- Professional development opportunities
- Wellness initiatives
- Flexibility in dress code and work arrangements
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingbeneficiary changeseligibility waiverslife insurance policiesdisability income policiesfraud detectionmedical terminologylegal terminologyanalytical skillsproblem-solving
Soft Skills
communication skillsorganizational skillscustomer service skillsteam collaborationtraining abilitiesinvestigative skillsattention to detailtime managementadaptabilityleadership
Certifications
Bachelor's degreeLOMA certificationInternational Claims Association certification