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Chief Life Claims Examiner Job

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Chief Life Claims Examiner
Job# 2730
Location:  MI
Education Requirements:  Bachelor’s degree required. Law degree or JD preferred.
Other Requirements:  Include:

  • 7+ years of progressive business experience in life, either underwriting, claims, compliance, risk management or legal.
  • 5 years contestable life claims adjudication experience.
  • In depth knowledge of appropriate insurance principles including but not limited to underwriting, risk management, legal and regulatory and claims processes.
  • Strong written and verbal communication skills.
  • Ability to be effective in a collaborative environment.
  • Strong analytical and interpretive skills.
  • Strong negotiation skills.
  • Insurance industry certifications preferred.
  • Core Competencies:
    • Achieves Results/Has Bias for Action:
      • Achieves stretch results.
      • Strong bias for action with sense of urgency and high energy.
      • Practices collaborative working environment to achieve more.
    • Attention to Detail:
      • Able to review data/documents for accuracy and consistency.
      • Act to prevent mistakes.
      • Follow procedures closely.
      • Keep records accurate and up to date.
      • Test services/applications rigorously when needed.
    • Uses Effective Communication Skills:
      • Candid, clear and concise in communication.
      • Effectively matches style, tone and method to audience.
      • Connects with intended audience.
      • Manages communication and feedback within the organization.
    • Displays Team Orientation:
      • Works collaboratively to achieve organization’s success.
    • Technical/Professional Skills:
      • Strives to stay ahead of technical/professional expertise.
      • Is proactive and inspires others to stay current in areas of technical expertise.
    • Resilience:
      • Able to interpret situations and information objectively when stressed.
      • Remain calm and professional in potentially volatile or emotionally charged interactions.
      • Maintain high productivity in stressful situations.
      • Maintain high performance in the face of setbacks or rejections.
      • View failures objectively and rebound quickly.

Salary Range:  $67k to $100k+ DOE
Description:  Operating within the core values and operating principles of the organization, the Chief Claims Examiner is responsible for the analysis and management of complex and contestable claims.  This position will review, investigate and make decisions regarding coverage, contestability, process generated liability exposure and appropriateness of claims.  This position will process and document claims to ensure compliance with company standards, industry best practices and legislative/regulatory provisions.  The Chief Claims Examiner will ensure that all contestable claims are adjudicated in a fair, timely and accurate manner in accordance to our Client’s core values.  Position responsibilities include:

  • Provide expert claims adjudication competencies for the enterprise and functional area.
  • Manage contestable and complex claims to determine contractual coverage, support business strategy and leverage industry best practices for claim adjudication.
  • Provide leadership around escalated claims, appeals and litigated claims.
  • Review of claims data looking for trends that can impact the business and reporting result to Senior Leadership.
  • Build cross-functional partnerships with other business units throughout the enterprise to deliver on business results and manage risks.
  • Build strong relationships with key partners and stakeholder including Policyholders, Actuarial, Risk Management, Underwriting, Compliance and Special Investigations.
  • Coordinates vendor referrals and utilize other data sources for additional investigation and/or litigation management.
  • Communicates effectively with all appropriate parties involved with a claim.
  • Executes claims activities to ensure consistent delivery of high quality claims service.

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