Claims Associate

Pan-American Life Insurance Group (PALIG) is seeking a Claims Associate who will be one of the primary interfaces with our beneficiaries requiring utmost professionalism in interacting with individuals during the claims process.  The Claims Associate will be a primary team member to handle critical administrative duties related to time sensitive claim processing.

The Claims Associate is responsible for receiving all notices of claims and incurring the claim for administration in the various system applications, maintains records for claims, and ensures all claim documentation is properly organized and complete for auditing purposes. Serves as the liaison for records between the department and various relevant parties including the various auditing agents, internal and external. Answers questions for claimants or others regarding coverage amounts and contingencies affecting payment allocation. May specialize in a specific field such as life and/or disability. May provide other assistance to examiners during investigations.  Handles moderately complex issues and problems and refers more complex issues to higher-level staff. Possesses solid working knowledge of subject matter.

ESSENTIAL FUNCTIONS:

Client communication:

• Effectively communicates with customers
• Conveys empathy and maintains a high level of professionalism
• Responsible for responding to client inquiries received via phone, mail, or email

Manages Death Claims:

• Receive and incur new death death claims
• Review policy record, document appropriate workflow and policy administration systems, prepare and release generic claim requirement packets  
• Review pending claims and follow up regularly with beneficiaries to obtain claim documents
• Assist the Claims Examiner in obtaining any other supporting documentation necessary to review and process the claim, including but not limited to medical records
• Prepare and mail all final and closing file notifications and work with Management to identify possible movement to unclaimed or abandoned property
• Receive all claim documentation, update all relevant systems with required information/documentation, request pending claim documentation
• Review and categorize all claim documentation according to established procedures and ensure all claim documentation is properly archived to imaging systems (PALIG)
• Receive and respond to policy locator requests

Beneficiary verifications and change of beneficiaries:

• Receive and prepare requests for beneficiary verifications, update appropriate systems as needed
• Receive and process change of beneficiary requests

Manages Disability Claims:

• Receive and incur new disability claims; communicate with third party administrator and reinsurers as needed
• Receive daily disability payments reports, review, and process in system
• Maintain proper documentation of processed daily disability claim payments, review against daily payment reports to ensure accuracy
• Ensure all insured records from TPA reconcile with PALIC records, take appropriate action if discrepancies are found
• Review monthly report from TPA to ensure new claims and take appropriate action in systems for closed claims

Life Waiver Claims:

• Review all incoming Life Waiver Claim documentation and forward to Claims Examiner for evaluation
• Prepare all correspondence and mail all relevant forms for all continuation of life waiver benefit claims. Review records when received and forward to claims Examiners for final determination.
• Assist Claims Examiner with all life waiver claims related process including but not limited to ordering medical records when applicable

Death Master File:

• Download and review the weekly and quarterly report receiving from our third party administrator
• Identify potential death claims and validate death of insured. Update all necessary system application to initiate the claims’ process.
• Identify possible owner deaths and validate. Update all necessary system applications to initiate the process of updating the ownership under the contract stipulations.
• Identify possible deceased Settlement Contracts beneficiaries and validate. Update all necessary system applications to initiate the final payment by the Financial Services Dept.
• Quarterly upload and review of data for validation against the SSA DMF.

KEY REQUIREMENTS:

• High school diploma or equivalent, Bachelor's degree in related field preferred
• 1 year of relevant work experience; prior insurance industry experience preferred

KEY SUCCESS FACSTORS:

• Customer Service: Knowledge of principles and processes for providing customer services, such as needs assessment, meeting quality standards for services and evaluating service delivery satisfaction
• Writing/Reading: Understands documents and applies the information to work situations; conveys ideas and facts concisely and accurately in writing.
• Attention to Detail: Accomplishes tasks by focusing on all areas involved; ensures all associated processes and tasks are completed; vigilantly watches over/checks processes and tasks to ensure accuracy.
• Problem Solving Skills : Analyzes a situation by gathering and organizing information; assesses cause and effect relationships and recommends potential solutions. 
• Flexibility: Maintains an open mind; performs a wide variety of tasks and changes focus as demands change; transitions smoothly from one task to another as customer demands change.
• Organization/Planning: Plans and prioritizes tasks to ensure work is completed accurately and timely.
• Teamwork: Works with others to get results; responds positively to instructions and procedures; shares information with everyone on a project.
• Computer Applications: Remains current on knowledge of applicable computer applications and basic computer functions
• Basic Accounting knowledge

Pan-American Life Insurance Group Offers:

• Comprehensive Compensation Packages (base & bonus)
• Comprehensive Benefits Package: Medical, Dental, 401K, Paid Time Off, and Tuition Reimbursement, etc. are some examples. New hires are eligible for medical and dental coverage on the first of the month following 30 days of service.  

Who We Are:

Pan-American Life Insurance Group (PALIG) serves the life, accident, and health insurance needs of individuals and businesses in 49 U.S. states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands through its U.S. based member companies - Pan-American Life Insurance Company and Pan-American Assurance Company.

At Pan-American Life, our employees are our greatest asset. We are grateful for the collaborative efforts of our employees and partners, and for the confidence of the policyholders whose life and health we protect. It is through this long-standing commitment that Pan-American Life continues to succeed.

Pan-American Life is an Equal Opportunity Employer/Drug Free Workplace.