[Hiring] Claims Representative II @Banner Life family of companies

Role Description

The Claims Representative II researches, evaluates, and processes non-contestable and complex life and health claims in accordance with contractual, regulatory, productivity, and quality requirements. The role communicates with claimants and business partners, maintains complete claim records, supports reinsurance and accounting activities, and helps resolve claims-related issues accurately and efficiently.

• Establish, research, and process non-contestable and complex claims within established productivity and quality standards.
• Review company and policy records; use approved databases and search methods to confirm coverage, claimant identity, and claim validity.
• Review beneficiary and ownership changes, collateral assignments, estates, trusts, minor-beneficiary requirements, divorce statutes, and other applicable requirements to determine payment eligibility.
• Evaluate accelerated death, foreign death, waiver, and accidental death claims; request investigations or additional documentation when needed.
• Identify fraud indicators and escalate potential concerns, including issues involving foreign death claims.
• Open and maintain claim files in accordance with departmental procedures, documenting all material activity and decisions.
• Follow up on pending claims within applicable contractual, regulatory, and departmental timeframes.
• Apply escheat procedures and conduct public-record searches when required.
• Process settlements and payments in administrative systems using applicable postmortem-interest statutes, dividend calculations, and contract provisions.
• Prepare disbursement correspondence and document interest and payment amounts in the claim file.
• Complete required tax form reviews and filings, including Form 712, when applicable.
• Process manual policy accounting and reconciliations of suspense accounts where required.
• Communicate clearly and professionally with claimants, attorneys, agents, reinsurers, and internal partners regarding claim requirements, status, and resolution.
• Respond to calls and correspondence related to initial claim notifications.
• Review pending claims with management, identify barriers, and recommend appropriate solutions.
• Consult with other departments to resolve claims administration issues, including competing claim matters.
• Notify reinsurers of newly filed death or waiver claims and bill them for their share of applicable liabilities.
• Communicate with reinsurers to resolve case-specific issues and follow up on outstanding recoverables.
• Provide reporting and analytical support for monthly death-verification reviews and other assigned initiatives.
• Assist with training claims representatives on specialized claims processes.
• Develop analytical methods and reporting formats for special projects assigned by management.
• Perform other related duties and projects as assigned.

Qualifications

• At least two years of experience as a Claims Representative I or comparable claims experience.
• Advanced knowledge of claims practices, claims systems, policy records, life insurance products, and contract provisions.
• Some college coursework.
• Three to five years of experience in claims, customer service, or a related insurance administrative role.
• LOMA 281, LOMA 291, and ACS 100 coursework.
• Typing speed of at least 35 words per minute.
• Strong attention to detail, organization, prioritization, and time-management skills.
• Excellent written and verbal communication and customer service skills.
• Sound decision-making, problem-solving, analytical, technical, and negotiation skills.
• Ability to interpret contract language and provisions and apply product knowledge accurately.
• Ability to collaborate effectively with colleagues and business partners.
• Ability to work accurately in a fast-paced environment while managing multiple priorities.
• Proficiency in Microsoft Word and Excel.

Benefits

• The expected hiring compensation range for this position is $55,200 - $65,000 annually.
• This is a remote opportunity working from 8:30 AM to 5 PM EST.
• The total compensation package may include long-term incentives and annual bonuses.
• This role is eligible to participate in the Annual Incentive Plan with a current target payment of 3% of base salary.
• 10 vacation days and 10 sick days accrued bi-weekly.
• 9 paid holidays throughout the calendar year.
• Health, life, and dental insurance.
• 401K with company match up to 6% and a pension package.
• Generous time off and wellbeing initiatives throughout the year.
• Support for professional development and mentorship.
• Opportunities to volunteer for causes that matter most to you.