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Life Insurance Claims Examiner

Efinancial

This is a Full-time position in Chicago, IL posted February 21, 2021.

Who we are:Fidelity Life is a leading provider of financial security for middle market consumers. With a history of innovation, the company is redefining the life insurance industry with patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process and revolutionize the speed with which policies can be issued. Established in 1896, Fidelity Life enjoys a long track-record of success and continues to build its reputation of sound fiscal management and customer-focused innovation.In concert with Fidelity Life, eFinancial is an online and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary and patented sales technology platform, eFinancial operates call centers in Chicago, IL; Seattle, WA; and Tempe, AZ. eFinancial’s licensed agents and representatives reach thousands of consumers each day to help meet their unique life insurance needs – often with just a single phone call. To complement this channel, the company recently expanded to offer an entirely digital purchase experience.Together, Fidelity Life and eFinancial are revolutionizing the life insurance industry to make life insurance more accessible and affordable for everyday Americans. With an integrated marketing, product manufacturing, and controlled distribution system, the enterprise is uniquely positioned for growth.What the job looks like:While this role is based out of Chicago, IL, we are open to 100% remote!The Claims Examiner works in conjunction with Fidelity Life’s third-party administrator and the Business Services Executive (Claims) to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.What you will contribute:* Communicate effectively and respectfully with customers and co-workers via phone, e-mail, on-line chat and in-person.* Review newly reported claims and enter them on the pending claims log.* In accordance with established departmental procedures, document each claim file with detailed notes regarding the review, information needed/obtained, and the decision regarding the claim.* Review and interpret insurance policy provisions as they relate to the claim presented to ensure an accurate claim decision is made.* Review any adverse decisions, and decisions outside authority limit, with the Business Services Executive (Claims). Consult with the Legal Department as needed.* On claims within the Claims Examiner’s authority limit, confirm benefits and statutory interest are calculated correctly.* As needed, respond to customer (including attorneys) inquiries regarding claim matters via telephone, written correspondence or e-mail. Consult with the Business Services Executive (Claims) and/or the Legal Department as needed.* Work with Fidelity Life’s Underwriting Department on contestable claim referrals and other complex claims as needed.* Handle and log specific State and NAIC policy locator searches.* Mentor and support third-party claims administration staff.* Keep management abreast of any trends in claims experience, unfavorable or otherwise, being observed and offer solutions and implement changes to correct such trends.* Work on special projects and other duties as assigned by the Business Services Executive (Claims).What you should bring to the table:* 5+ years of life claims experience required* Proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).* Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.* Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.* Ability to meet deadlines while performing multiple functions.* Proficient in MS Office applications and the Internet.* Ability to proactively analyze and resolve problems.* Attention to detail.* Flexibility and willingness to adapt to changing responsibilities.* Excellent written communication, interpersonal and verbal skills.* Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.* Proactive and outside-the-box thinker.* Independent and organized work style.* Ability to maintain strong performance while working remotely, if applicable.* Ability to use good judgment and discretion with highly confidential business, employee, consumer and customer information.* Team player and creative thinker highly desired.* College level coursework or equivalent work experience.EEOC/Other:Efinancial LLC, Fidelity Life Association, its parents subsidiaries and affiliates (collectively “The Company”) are equal employment opportunity employers. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, gender identity, marital status, age, disability or any status protected by law. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

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