Description

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We’re looking for a Claims Analyst to join our Insurance Operations team at MBPS. In this role, you are responsible for the overall review, assessment, and decision on payment for claims.

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Position Responsibilities:

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• Responsible for the complete assessment, calculation and final decision on claims (ex. Group life, AD&D, Survivor Income claims, TDMI, Personal Benefits as well as Compassionate Assistance Program loans.
• Adjudicate and make independent decisions on non-contestable and contestable claims (i.e. Evidence of Insurability (E of I) and pre-existing conditions) within defined authority levels.
• Operates within well-defined guidelines and processes/practices for routine claims. Identify invalid claims, detect fraud or misrepresentation and identify unusual facts to minimize liability of paying multiple claims Identify rival claim situations, take necessary steps and work with internal legal department for Payment into Court.
• Review and interpret policy contracts, procedures and administrative systems to determine the total death benefit payable, tax implications and any continuing coverage options available.
• Correspond with internal life moments team, beneficiaries, lawyers, advisors and executors on requirements and outstanding issues.
• Provide on the job training to new approvers on non-contestable and contestable claims processing and procedures.
• Responsible for communicating to internal partners as appropriate (i.e. Life Moments, Admin Advantage, Regional Group Offices (RGO.)
• Ensuring excellence in customer service by answering questions of interested parties (internal/external) re processes/procedures prior to claims submissions (i.e. review of beneficiary designations, process/procedures etc.)
• Responsible for identifying claims which fall within Unclaimed Property guidelines and following appropriate steps.
• Dealing with conflicts effectively (i.e. beneficiary/advisor/ rival claim situations/internal partners challenging our request for medical, legal or claims requirements)
• Ensuring proper requirements and service standards are met, especially when volumes are high Keeping current with new systems and products
• Recognizing unusual or non-routine claims outside of procedures that require special investigation or handling

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Required Qualifications:

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• Minimum of 2 years in a relevant back-office role, with at least 6 months of experience in voice call handling.
• Familiarity in Microsoft Office (Excel, Word, Outlook).
• Strong verbal and written communication skills.
• College degree or equivalent business experience.

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Preferred Qualifications:

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• Analytical and problem-solving skills, including strong attention to detail, to identify unusual claims and interpret policy contracts.
• Good understanding of Insurance and claims systems and products
• Familiarity with medical terminology (i.e. Assessment of covered losses under accidental dismemberment, CAP loans, Evidence of Insurability and pre-existing investigations, TDMI).
• Knowledge of accounting, tax and legal implications relating to claims.
• Excellent customer service skills and demonstrated empathy to deal with sensitive information and grieving customers
• Organizational skills to be able to work in a high volume, fast-paced environment

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