Waiver of Premium Claims Specialist

Northwestern Mutual • Franklin, WI

2d • Remote

About The Position

The Waiver of Premium Claims Specialist analyzes eligibility for newly requested and complex Waiver of Premium Benefits. This involves investigating, analyzing, and approving or denying Waiver of Premium claims, as well as approving or denying benefits on active claims. The role requires extensive medical, legal, policy, and claim knowledge to interpret facts and make consistent claim decisions. The specialist will actively manage claim files, communicate with various stakeholders including insureds, medical practitioners, and attorneys, and may represent the company in legal matters.

Requirements

• Bachelor's degree or equivalent combination of education and progressively responsible work experience, preferably in the area of health care, business, insurance, law, or communication
• One to three years of responsible and relevant work experience demonstrating analytical ability, independent decision-making and sound judgment in the application of guidelines
• Strong analytical skills that ensure a fair and consistent decision-making process
• Superior organizational and time management skills
• Customer-centric communication, both written and verbal, with a focus on our policyowners and field force
• High degree of self-motivation and initiative in taking responsibility for own work while contributing to team goals; able to collaborate within and across teams to obtain the best possible result

Nice To Haves

• Knowledge of medical terminology as well as experience with insurance contracts and field servicing preferred
• Experience handling Waiver of Premium and/or Disability Income claims preferred
• Experience working with claim management systems such as DI Benefits Connection and Claims Platform

Responsibilities

• Investigates, analyzes and approves or denies complex contestable and non-contestable Waiver of Premium claims, including, but not limited to those for unemployed, retired, homemaker, child, late, no liability, Financial Representative, and terminated policies.
• Uses extensive medical, legal, policy and claims knowledge in interpreting and analyzing pertinent facts to reach claim decisions consistent with our claim philosophy.
• Orders and reviews appropriate medical, investigative, and other information needed to determine the eligibility of claims.
• Manages claim files actively by evaluating claim information and making decisions regarding approval, denial, continuing benefits, and terminations on a regular, ongoing basis.
• Communicates verbally and in writing with Insureds, field force, medical practitioners and related facilities, attorneys, other insurance companies, appointed representatives, employers, government agencies and divisional resources involving negotiation and conflict resolution.
• Preserves Northwestern Mutual's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.
• As part of the claim handling process, may be called upon to represent the Company in legal matters through preparation for and participation in depositions and trials.
• Actively participates in committee and project work, based on business need.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 1,001-5,000 employees