Sr Claims Examiner II

Penn Mutual•Philadelphia, PA

7d•$65,000 - $75,000

About The Position

The Sr Claims Examiner II is a subject matter expert responsible for handling highly complex and sensitive claims within Life, Annuity, RPS, or a combination of all three, including escalated cases, requiring advanced judgment and interpretation. This role provides leadership in process improvements, mentors junior examiners, and serves as a key resource for technical guidance. The position requires deep expertise, strong analytical skills, and the ability to manage risk effectively.

Requirements

Expert knowledge of life insurance products, claims processes, and regulatory requirements.
Advanced analytical and decision-making skills with ability to interpret complex contracts.
Ability to multitask and adapt to a changing environment.
Detail oriented, organized and accurate.
Strong leadership and mentoring capabilities.
Excellent communication and relationship building skills with a customer service mindset.
Proficiency in claims systems and advanced digital tools.
Ability to manage risk and drive continuous improvement initiatives.
Proven experience implementing AI tools to automate or improve work processes.
Bachelor’s degree required
Minimum 5–7 years of experience in life, annuity, and/or RPS (combined) claims required

Nice To Haves

Master’s degree preferred
10+ years preferred for complex case handling
Industry certifications (e.g., ALHC, FLMI, Series 6 or 26, HIAA, etc.) strongly preferred.

Responsibilities

Independently adjudicate highly complex life, annuity, and/or RPS death claims, ensuring compliance with all regulatory and contractual requirements.
Exercise sound judgement and utilize appropriate medical and risk resources, adhering to referral policies, and transferring claims to appropriate risk level in timely manner.
Demonstrate strong relationship building, customer service and communication when interacting with customers and business partners.
Serve as an escalation point for unusual or disputed cases, providing expert analysis and resolution.
Lead investigations into complex claims and collaborate with legal, compliance, and other departments as needed.
Mentor and provide technical guidance to Sr Claims Examiner I and other team members.
Identify and implement process improvements to enhance efficiency and accuracy.
Represent the claims function in cross-functional projects and initiatives.
Adheres to Service Level Agreements (SLAs) and individual/team metrics.
Ability to work core business hours between 8:30 AM to 6:00 PM EST.