Life Claims Examiner (HYBRID or REMOTE)

Equitable•Syracuse, NY

5d•$53,000 - $62,000•Hybrid

About The Position

Equitable is seeking an influential and dynamic Claims Examiner to join our Group Life Claims organization. The Claims Examiner is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions. This position offers a flexible work schedule: it may be fully remote/hybrid. If you are located near one of our offices (e.g., Charlotte, NC; New York, NY; Syracuse, NY), a hybrid schedule with 2–3 days on-site per week is expected to foster collaboration and connection.

Requirements

2+ years prior experience managing Life claim products.
Excellent client relationship management skills.
Strong verbal, written communication, and presentation skills.
Comfortable dealing with complexity and ambiguity and able to explore multiple solutions.

Nice To Haves

Previous experience with FINEOS Claims software platform highly desired.
Exceptional customer service skills; Proven skills in positive and effective interaction with challenging customers.
Strong knowledge of regulatory requirements for Life claims.
Ability to handle sensitive information with confidentiality and professionalism.
Strong written and oral communication skills demonstrated in previous work experience.
Excellent organizational and time management skills with ability to multitask and prioritize deadlines.
Ability to manage multiple and changing priorities.
Detail oriented; able to analyze and research contract information.
Demonstrated ability to operate with a sense of urgency.
Experience in effectively meeting/exceeding individual professional expectations and team goals.
Demonstrated analytical and math skills.
Ability to exercise critical thinking skills, risk management skills and sound judgment.
Ability to adapt, problem solve quickly and communicate effective solutions.
High level of flexibility to adapt to the changing needs of the organization.
Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
Continuous improvement mindset
A commitment to support a work environment that fosters diversity and inclusion.
Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.
Reliability and dependability throughout our extensive training program is crucial.

Responsibilities

Responsible for active case management of Life claims.
Ensures claims are processed accurately within regulatory and company guidelines.
Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved.
Review and interpret medical records, utilizing resources as appropriate.
Complete financial calculations specific to claims when applicable.
Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication.
Apply contract/policy provisions to ensure accurate eligibility and liability decisions.
Demonstrate and apply analytical and critical thinking skills.
Foster strong relationships with customers to understand their needs and ensure high levels of satisfaction.
Addresses and resolves any customer challenges or concerns promptly.
Communication via telephone, email, and text with employees, employers, attorneys, and others.
Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards.
Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities.
Work independently as well as within a team structure.