Claims Representative II

Banner Life family of companies • Frederick, MD

3d • $55,200 - $65,000 • Remote

About The Position

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.

This remote opportunity is scheduled from 8:30 AM to 5:00 PM EST. The expected annual hiring compensation range is $55,200–$65,000. The role is eligible for the Annual Incentive Plan, with a current target payment of 3% of base salary, modified for corporate and individual performance and prorated based on start date. Employees receive accrued vacation and sick time, paid holidays, and a competitive benefits package. Employment is at will.

Requirements

• 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.
• 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.

Nice To Haves

• 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.

Responsibilities

• Establish, research, and process non-contestable and complex claims within established productivity and quality standards.
• Review company and policy records and 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 reconcile 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.

Benefits

• Annual Incentive Plan with a current target payment of 3% of base salary, modified for corporate and individual performance and prorated based on start date.
• 10 vacation days accrued bi-weekly.
• 10 sick days accrued bi-weekly.
• 9 paid holidays throughout the calendar year.
• Health insurance.
• Life insurance.
• Dental insurance.
• 401(k) with company match up to 6%.
• Pension package.
• Wellbeing initiatives.
• Professional development support and mentoring.
• Time off to volunteer.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed