QUALIFICATIONS/REQUIREMENTS:
- Bachelor of Arts or Sciences degree in business field, related field, or equivalent work experience
- At least 4 years of practical insurance claim experience
- The ability to use resources effectively, exercising good judgment, possessing decision-making ability, and applying knowledge and experience to related situations so that many types of requests can be handled independently
- Ability to professionally interact with business people of all levels and succinctly communicate information to internal and external customers. General understanding of corporate multiline products, procedures and practices.
- Demonstrates knowledge of company administrative systems, and software. Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications.
DUTIES/RESPONSIBILITIES:
- Analyze claims and determine their validity based on policy provisions, riders, waivers, operating procedures, and state regulations; determine if additional data is necessary; calculate the benefits payable and any interest due; insure that valid claims are reviewed and paid in a prompt and equitable manner or declines payment of benefits when loss is not covered under the terms and provisions of the policy. The maximum claim authority per file is $10,500.00.
- Provide superior customer service to claimants or their representatives through written correspondence, telephone, and face-to-face contact in a courteous, tactful, and appropriate manner. Prepare tax forms, state notice forms, and state consent forms when applicable
- Maintain working knowledge of adjudication and reporting responsibilities within department and provide assistance to other examiners as workload or absence dictates to ensure claims are handled in a timely manner
- Order investigations on suicide, homicide, and accidental death claims to determine Company’s liability. Investigate abandoned property cases and comply with regulations. Administer reinsurance reporting and communication and assure proper reconciliation.
- Determine from medical records received, approval or denial of contestable claims; request medical information from doctors and hospitals, as needed. Upon receipt, review and determine whether benefits are applicable, and pay or decline claims
- Approve and request claim expense checks for outside investigations and attorney’s fees
- Continually expand knowledge of human anatomy and physiology, disease processes and medical practices and procedures, and consult with Underwriting or Medical Director as needed
- Continually expand knowledge of legal decisions, opinions, proper practices and procedures and consult with Legal department as needed. Alert to spot red flags for potential fraud instances.
- Perform other department duties as assigned by Manager.
Kansas City Life Insurance Company is committed to equal employment opportunities for all individuals regardless of race, religion, color, sex, age, national origin, disability, or genetic information.
Regular and reliable attendance and punctuality is an essential function of this position.
