February 09, 2024

Claims Examiner

Locations: Baton Rouge, LA; Lincoln, NE; Cedar Rapids, IA; Des Moines, IA; Rosemont/Chicago, IL

Kuvare is a growth-oriented insurance platform that delivers diversified annuities, life insurance, and supplemental products to the middle-income and mass-affluent consumer segments through its acquisition-led growth strategy. Kuvare provides proven capabilities, strategic support, substantial resources, and patient capital to help insurance companies pursue and achieve sustainable growth opportunities. With its patient capital, Kuvare targets differentiated annuity and life insurance companies to bring into its family of brands. 

Summary/Objective

Claims Examiners are confident decision-makers playing an important oversight role in the claims process. To process, monitor, review and approve/deny disability income, waiver of premium, life claims. This includes reviewing medical information and case history to determine if additional investigation is required. Inform, notify, educate, and communicate with agents, insureds/claimants, beneficiaries, and internal departments. To monitor and maintain claims computer system and reports for accuracy and efficiency.

Duties and Responsibilities

Duties and responsibilities include, but are not limited to:

  • Review claims reports and mail. Analyze investigative material for coverage to determine if claim is to be paid or denied, and if policy/certificate needs to be reformed/rescinded.
  • Maintain contact with agents and corporate legal counsel as needed.
  • Process payments and correspondence on a timely basis to assure accurate and prompt processing.
  • Responsible for annuity proceeds, payouts, surrender charges, withholding calculations, and deferred settlement options.
  • Review new claims. Determine if coverage is in force and claim is valid. Set up file; request additional information needed. Initial review includes reinsurance participation, contestability, beneficiary designations, coverage exclusions.
  • Review claims, determine coverage in accordance with the contract, and conclude what, if any, benefit applies and the amount to be reimbursed.
  • Document all follow-up activities
  • Organize work/resources to accomplish objectives and meet deadlines
  • Maintain compliance with federal and state regulations
  • Maintain the privacy and security of all confidential and protected information; uses and discloses only that information which is necessary to perform the function of the job
  • Demonstrate the willingness and ability to work collaboratively with other key internal and external staff to obtain necessary information both internal and external partners.
  • Participate in all educational activities and demonstrates personal responsibility for job performance
  • Take initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate
  • Consistently demonstrate a positive and professional attitude at work
  • Deliver a high standard of service and empathy when following up with customers by letter, email, or telephone once the claim has been resolved.
  • Efficiently answer incoming telephone or email inquiries from customers about the status of their claim, striving for excellence at every touchpoint.
  • Work with other departments to maintain and update claims system and ensure accuracy of reports. Maintain relationships with underwriters, auditors, marketing personnel, beneficiaries, agents, insureds/claimants, and creditors.
  • Accurately research discrepancies and be responsible for escalating questionable claims to your manager.

Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Experience

  • Bachelor’s degree preferred.
  • 5 + years’ experience providing customer service and transaction processing support in insurance or financial services.

Skills/Competencies

  • Ability to work effectively with other internal teams and associates.
  • Good interpersonal and communication skills
  • Proficiency in mathematics and spreadsheet software.
  • Demonstrated decision-making ability.
  • Ability to communicate effectively both orally and in writing.
  • Ability to build productive internal/external working relationships.
  • Strong analytical skills.
  • Advanced organizational skills and attention to detail.
  • Strong verbal, written and listening communication skills.
  • Strong risk assessment and conflict resolution skills.
  • Ability to collaborate with key partners and business leaders
  • Ability to read and interpret contract language
  • Proficient on Microsoft Office Suite
  • Ability to work independently with minimal supervision
  • Demonstrated ability to deliver results under pressure in a tight timeframe preferred
  • Knowledge of annuities and life plans and processes highly desirable
  • Proven track record of process improvement and innovation desirable

Physical Demands

  • Normal office working environment.
  • Ability to sit for extended periods of time.
  • Ability to type / perform data entry.
  • Ability to read from a computer screen and paper reports.

Kuvare company is an equal opportunity employer that makes hiring decisions based on merit, qualifications, and the business need. We are dedicated to a policy of nondiscrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions. We encourage all qualified candidates to apply.

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