Claim Examiner

Job Description

Job Description

All Boston Mutual employees who interact with our policyholders, our producers, and our BML associates embrace the principles of our brand and service philosophy. We are all brand ambassadors. Both our words and our behaviors matter. We share a common service philosophy and pride ourselves in living the BML brand promises every day, one interaction at a time.

The following statements represent what Boston Mutual stands “FOR” – it is what makes us different and better in the market we serve.

• We are FOR being a progressive life insurance company offering financial peace of mind to working Americans and their families.
• We are FOR providing practical and affordable products designed for those we serve.
• We are FOR making it easy to secure a level of financial protection with a portfolio of products – beginning with life insurance.
• We are FOR providing a personalized customer experience to our policyholders and producers.

• We are FOR acting in the best interests of our policyholders, producers, employees and the communities in which we live and serve – representing the goodness of mutuality in all we do.

We do our best to:

• Demonstrate a desire to assist
• Listen for understanding and respond empathetically
• Explain things in a manner that is easy to understand
• Be knowledgeable students of our business
• Take full ownership to resolve questions and issues
• Be professional, polite and courteous
• Leave our customers and associates “better than where we found them”

Statement of Position

The Life Claim Examiner reports directly to the Life Claim Manager.

The Life Claim Examiner is responsible for managing and processing all assigned claims with adherence to company policies and contract provisions in full accordance of the law while demonstrating the highest levels of service professionalism in all they do.

The Life Claim Examiner is expected to:

• Manage their assigned caseload of Life insurance claims and ensures the accuracy and completeness of submitted claims.
• Processes assigned claims for payment or denial in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality/production standards.
• Review and process claims, evaluate medical records, and request additional information when needed.
• Obtains claim information by communicating effectively with internal/external stakeholders verbally and in written form while maintaining a professional demeanor. Interpret and evaluate policy/contract revisions.
• Review pending claims on a monthly basis.
• Perform other duties as assigned.

JOB REQUIREMENTS AND QUALIFICATIONS

Education: High School Diploma, GED or equivalent required. Medical terminology and/or insurance experience preferred.

Experience:

Claim examiner: Minimum of 1 year of business/office experience.

Sr. Claim Examiner: Minimum of 2 years life/medical claims experience required.

Knowledge Requirements:

• Strong business knowledge
• Excellent written/verbal communication skills.
• Strong organizational skills that reflect ability to perform and prioritize a high volume of task.
• Multitasks seamlessly with excellent attention to context, substance, and detail while meeting goals and strict deadlines.
• Excellent interpersonal skills and the ability to effectively build and extend relationships.
• Working knowledge of desktop applications such as Outlook, Word and Excel.

Hybrid Work Model

At our Canton location, most employees will be on site Monday - Thursday. At our Omaha location, employees will be on site 2 days per week

Boston Mutual is an equal opportunity employer, and does not discriminate on the basis of race, color, age, religious creed, national origin, ancestry, sex, sexual orientation, gender identity, genetic information, disability, military service, veteran status, family status, pregnancy, or any other characteristic protected by federal or state laws. Boston Mutual is a drug-free workplace.

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