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Senior Claims Examiner
Genworth Financial
Lynchburg, VA, United States
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POSITION
Associate Life & Annuity Claims Specialist
LOCATION
Lynchburg, VA
COMPANY
Genworth is a Fortune 500 financial services company providing financial security and protection through our Mortgage Insurance and Long Term Care Insurance businesses. Our purpose is to help families achieve the dream of homeownership and address the financial challenges of aging. At Genworth, our promise to our employees is the opportunity to make a meaningful difference in the lives of our customers, our communities, and one another. We issued our first life insurance policy in 1871, our first annuity contract in 1928, and our first long term care insurance policy in 1974. Today, nearly 4 million customers rely on Genworth's U.S. Life Insurance Companies.
POSITION SUMMARY
This position serves as the primary subject matter expert for all life claims during the contestability period, handles the review of lapsed claims and manages new waiver processes.
RESPONSIBILITIES
• Investigates contestable claims to verify information provided on the insurance application. Investigations include ordering and reviewing medical records, criminal record reports, driving records, autopsy reports, police reports and conducting next of kin interviews.
• Prepares files for legal review including consultation with Claims Counsel, written and verbal communication as well as appropriate follow-up with beneficiaries, attorneys, Attorneys-in-fact, and other parties to the claim or legal matter. Preparation of documents for outside counsel as needed.
• Seeks to provide fair adjudication by thoroughly reviewing information, pinpointing misrepresentations and/or fraud, to determine if claims are payable.
• Effectively resolves problems, expedites claim handling, assists with form completion and develops strong relationships with customers, focusing primarily on customer needs, providing compassion and comfort during a very difficult time in their lives.
• Processes payments for death claims, reinsurance and waiver benefit refunds
• Takes responsibility for Consumer and Department of Insurance Complaints. This includes logging, researching, and working with Claims Counsel to ensure proper written response is provided. Additionally, ensuring that process improvements are implemented if the complaint identified an area of improvement.
• May meet with business leaders and/or individual associates to discuss complaints on an as needed basis, including providing timely feedback on issues discovered during review
• May analyze data/complaints as needed, and work with business to identify trends and propose solutions; makes recommendations for changes to business processes as a result of research.
• Promptly manage the processing for waiver of premium claims and analyzing policy language for the waiver of premium riders to determine eligibility.
• Correspond with outside customers to convey claim filing requirements.
• Analyze all incoming documents for appropriateness and completeness, and may determine whether claim is eligible for waiver of premium. If so, may also calculate benefit amounts and serve as 1st approver for payments.
• Data enter all information received and satisfy requirements in the waiver system, which includes but not limited to physical capability forms, attending physician statements and claimant statements.
• In addition to the waiver system, update all administrative systems with appropriate waiver coding.
• Serves as the first step in resolving claims adjudication issues and in the call escalation process.
• May test system upgrades to validate system changes and functionality in regards to all upgrades.
• Maintain claim inventories within department guidelines by staying aware of current levels and understanding how to realign resources to meet goals.
• Responsible for managing all follow-ups and mailing letters within department guidelines.
• Handles inbound and outbound phone calls for [waiver] questions and assisting policy owners with the claim process.
• Remains current on regulatory, compliance, product, and/or process changes.
• May also be responsible for:
• Approving contestable and waiver payments as well as back-up approver for incontestable claims
• Handling the review of continuing waivers and other waiver processes
• Handling the review of lapsed claims
• Assisting the processing teams in high volume situations
• Other duties as assigned to assist the department in reaching its goals
REQUIRED QUALIFICATIONS:
• Two-year college degree or equivalent life/annuity/LTC insurance, disability, waiver or tax-related experience.
• Minimum of 2 years fixed life/annuity/LTC claims experience with demonstrated record of above average performance.
• Able to interpret, understand and apply policy/contract language and other information and to determine the need for additional information to properly determine risk and/or fraud potential.
• Process improvement focus with willingness to develop and maintain professional growth
• Demonstrated ability to:
• Diffuse escalated situations
• Initiate and adapt quickly to change
• Communicate effectively (i.e., verbal, listening, and written skills)
• Relate to others and work well within a team structure to accomplish goals
• Work independently with minimal supervision
• Organize daily activities and remain current with assigned tasks
• Analyze a situation and make sound decisions based on the information available
• Effectively communicate basis for decisions to explain actions to internal and external customers
PREFERRED QUALIFICATIONS
• Minimum of 2 years fixed life/annuity/LTC claims experience with demonstrated record of above average performance.
• Working knowledge of insurance products for both life and deferred annuities
• Demonstrated knowledge of and proficiency with Claims and business administration systems.
• Knowledge of Medical Terminology and/or health related job experience