Complex Life Claims Examiner

Job Title: Complex Life Claims Examiner
Location: This position is eligible for a fully remote work arrangement.

WoodmenLife is looking to hire a Complex Life Claims Examiner to join our team!

In this role, you will be responsible for conducting a thorough claim investigation on complex claims such as Accidental Death, Contestable, and Rival Claims along with other claim types. Responsible for effectively adjudicating their claims to direct effective outcome and to meet risk management, regulatory requirements, and in accordance with WoodmenLife’s policies and practices.

WoodmenLife is one of the best places to work in Omaha with over 135 years of service. As a member of the WoodmenLife family, you’re joining others who share your commitment to family, community and country. Through WoodmenLife, you’ll have opportunities to give back locally and honor those who make an impact. As a not-for-profit life insurance company, we’ve been helping to protect the financial future of families, making a difference in hometowns across America since 1890. We offer a variety of benefits ranging from health, dental, vision, 401K, life insurance and much more. Apply today to learn more!
We are looking for someone to:
• Processes accidental death claims and claims that fall within the contestability period, including suicide exclusion. Requests and reviews medical records, incident reports, coroner/autopsy reports, driving records and other pertinent information to make recommendations to Claim’s Management, including the drafting of rescission letter.
• Investigates, evaluates, and adjudicates claims more complex in nature with a level of independence, including the drafting of rescission letters and ensures adherence to claim processing policies, procedures, and regulatory guidelines.
• Partners with internal and external resources, to bring claims to an appropriate outcome. Partners with peers to ensure daily service is met.
• Collaborates with claim and underwriting management to track trends and identify gaps in the risk assessment and or field underwriting processes.
• Consults with management and Legal on claims investigations, denials and rescissions as well as interpretation of contracts and regulations to direct and make decisions on claims processing. Ensures that claims that are rescinded due to material misrepresentation are tracked for Schedule F reporting.
• Consults with the Legal Department when necessary and follows the “complaint” guidelines established by WoodmenLife. Corresponds with all parties on a regular basis until resolved. Communicates with the Legal Department through the interpleader process until the proceeds are paid.
• Adheres to Core Operation’s Behavioral Standards including focusing on solutions, being open to feedback and dialogue, taking initiative, and be involved and accountable.
• Meets expectations for attendance and punctuality in accordance with the expectations established by your supervisor and WoodmenLife policy.
• Performs other duties as assigned by management.
We need someone who has:
• Bachelor’s degree is preferred, however will consider commensurate work experience.
• Prefer 3+ years previous experience in claims processing or underwriting area.
• Prefer knowledge and demonstrated experience in medical terminology, medical disorders, and their significance to life insurance.
• Prefer completion of ICA certification program.
• Excellent writing and analytical skills.
• Ability to work with a high level of concentration and attention to detail.
• Ability to work very well independently however able to also support team.
• Demonstrated knowledge of WoodmenLife products and knowledge of Core Operations systems, policies and procedures.
• Demonstrated in-depth problem-solving capabilities, including ability to detect discrepancies, trends and efficiencies needed.
• Ability to understand and then clearly communicate information and answers to Home Office associates and external customers.
• Ability to provide and receive constructive feedback.
• Ability to maintain confidentiality, sensitivity, and professionalism.
• Ability to work well with others in a team environment.
If you're ready to make an impact in your community, we’d love to hear from you. Apply today!

As part of WoodmenLife’s employment process, candidates will be required to complete a criminal background check, credit check (when required for position), fingerprint check (when required for position), drug screen and reference checks. Any offer of employment will be contingent upon successfully passing the above.
WoodmenLife is welcoming to all regardless of background and beliefs. WoodmenLife respects every associate’s unique perspective and contribution. We are committed to creating an environment that v