Claims Specialist

Sammons Financial Group • West Des Moines, IA

8d

About The Position

The Claims Specialist requests and reviews claims requirements to determine coverage and finalize the settlement of policy and contract benefits in accordance with policy provisions, applicable state and federal legislation, settlement agreements, and company compliance and business requirements. The role follows up on outstanding requirements with agents, policyholders, beneficiaries, and attorneys, using professional written and verbal communication.

The specialist reviews policy and contract information, gathers supporting medical and legal records, and processes benefits once requirements are met. The role also handles claims-related inquiries, maintains service-level and quality standards, completes account balancing and reconciliations as needed, follows controls and pending-file follow-up procedures, and escalates complex matters to management or Legal. Additional work includes maintaining product, systems, tax, procedural, and compliance knowledge; participating in department improvements and problem-solving; and helping deliver a positive customer experience.

Requirements

• Ability to communicate effectively and tactfully with agents, policyholders, beneficiaries, and other staff members.
• Knowledge of and ability to navigate multiple information screens.
• Strong organizational skills.
• Ability to work efficiently and independently or as part of a team.
• Ability to adapt to frequent change, including daily transitions among work duties, tasks, and lines of business.
• Attention to detail and problem-solving skills.
• Computer skills, including PC and Microsoft Office.
• Excellent verbal and written communication skills.
• Criminal background check required.
• Fingerprinting required under FINRA regulations; management determines and approves incumbent suitability.
• Candidates must not require immigration sponsorship or work authorization for this role, now or in the future.

Nice To Haves

• Bachelor's degree preferred.
• 2–4 years of insurance or annuity/life claims experience preferred.
• Previous customer service experience preferred.

Responsibilities

• Request and follow up on outstanding claim requirements needed to finalize payable policy and contract benefits.
• Confirm requirements meet company, state, and regulatory standards before processing benefit payments.
• Complete policy and contract settlements within applicable service-level and quality standards.
• Review data and complete reviews required by audits and settlement agreements.
• Request and gather medical records, legal documents, duplicate policies, and other materials needed to determine coverage under policy, contract, and rider provisions.
• Escalate complex claims or benefit-related requests to the Manager and/or Legal Department.
• Respond in writing and by telephone to internal and external customers, agents, beneficiaries, attorneys, and policy or contract owners; handle claims calls professionally and according to company procedures and standards.
• Review and process benefit requests as needed in accordance with service-level and quality standards.
• Support initial claim notifications by researching policy and contract files and using industry-standard tools to determine coverage and payable beneficiaries.
• Participate in monthly department account balancing as needed, including suspense-account work, open-item suspense reports, and reconciliations.
• Follow procedures to maintain required controls.
• Follow up on pending claim files every 30 days in writing, or as required by state regulations.
• Respond to questions regarding audits, NCOIL legislation, and settlement agreements.
• Maintain knowledge of company products, current procedures, and assigned training requirements.
• Maintain basic system, tax, procedural, and compliance knowledge relevant to the Claims Department.
• Assist with projects that improve productivity and system integrity.
• Track and provide customer feedback through the ACT Log.
• Provide feedback and suggestions to the Manager to improve service and department efficiency.
• Model the company's shared values and interact respectfully with colleagues.
• Meet or exceed performance goals, including KPIs, SLAs, and other communicated standards.
• Participate in daily huddle discussions and problem-solving sessions as requested.
• Implement standard work and other changes in daily processes.
• Strive to provide a positive customer experience in customer interactions, request handling, and problem-solving.
• Perform other duties as assigned to support Claims Department processes and responsibilities.
• Maintain regular attendance and punctuality in accordance with company policy.

Benefits

• Comprehensive medical, dental, vision, HSA, and FSA coverage options, plus term life insurance.
• Performance-based incentive program tied to clear goals and individual and/or company success.
• 100% company-funded Employee Stock Ownership Plan (ESOP).
• Automatic enrollment in a 401(k).
• Friday afternoons off year-round.
• Generous paid time off and paid holidays.
• Paid development time.
• Tuition reimbursement.
• Professional development opportunities across industry, individual, and leadership programs.
• Volunteer time off.
• Company nonprofit matching gift program.

What This Job Offers

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