Life Claims Adjuster (Adjuster IV)

About This Role

The Life Claims Adjuster (Adjuster IV) is responsible for adjudicating claims and Return of Premium (ROP) claims based on variable contract provisions, benefits, and state guidelines. This role requires understanding policy contract language, insurance applications, state statutes, interpreting medical records, determining appropriate beneficiaries, identifying potential fraud, and correctly calculating benefits due.

Responsibilities

• Gather and review required documentation
• Conduct medical history investigations
• Conduct accident or homicide investigations
• Process ROP claims accurately and timely
• Establish eligibility and large dollar benefits
• Process claim payments accurately and timely
• Meet department quality and production standards
• Correspond with beneficiaries, customers, and co-workers clearly, accurately, and professionally
• Interact with beneficiaries, family members, and funeral homes via phone
• Provide assistance with ad hoc projects and operational initiatives as needed

Requirements

• Prior Life claim adjusting experience
• Experience reading and interpreting many different types of policy languages for benefit administration
• Basic knowledge of Microsoft Word and Excel a plus
• Previous Health/Life insurance Customer Service experience
• Basic ability to read and interpret medical records
• Excellent verbal communication on calls and written communication for request and benefit letters
• Ability to analyze risk and identify potential fraud flags
• Able to work within a production-based environment and meet quantity requirements
• Great attention to detail, good judgment, and strong organizational skills

Nice to have:

• Experience in Contestability or Rescission investigations

Benefits

• Medical
• Health Savings Account (including employer contribution)
• Dental
• Vision
• Dependent Care FSA
• Basic Life Insurance (full premium paid by employer)
• Voluntary Employee, Spouse and Child Life Insurance
• Short-Term and Long-Term Disability
• Paid Holidays
• Paid time off including vacation, personal days, sick time and Summer / Flex Fridays
• 401(k), 401(k) Match and Profit-Sharing Retirement Plan

Important Details

• Work format: on-site in Glenview, IL most days, with 3 flexible remote days per month
• Schedule: half-day Fridays every Friday