Claims Examiner (Remote) – R-118663

Claims Examiner (Remote) – R-118663
 

DESCRIPTION/RESPONSIBILITIES:
Job Classification:
Operations – Insurance Operations

The U.S. Back Office Customer Service (BOCS) organization is seeking a Claims Examiner to join our Group Life Claim Team of Beneficiary Fulfillment on our Specialized Client Concierge Team. Our Concierge Team strives to be customer obsessed by providing a “white glove” service throughout the life of the claim. This involves making outbound calls and providing a proactive approach to bring resolution to each claim. This is a high touch service model where you will be interacting daily with beneficiaries and families during a difficult time of loss. Customer Service skills, Empathy, and a willingness to help others are key skills for a successful candidate in this role.

The successful candidate will be trained to adjudicate life insurance claims for Group Insurance with a focus on accuracy, timeliness, and appropriate decision making. The candidate will also be trained to answer phone calls in order to assist beneficiaries and family members through the claim process. During in-classroom and on-the-job training, the incumbent will learn how to navigate our claim system, learn about our products, policies, and procedures and how to assist our customers at a time of critical need.

The successful candidate will be responsible for effectively adjudicating claims to meet production, quality, and service metrics in accordance with policy/procedures and regulatory guidelines. This entails working with both internal and external partners to obtain information required for claim handling. The center is open from 8:00am to 7:00pm Eastern Time Monday through Friday. To be considered, candidates must have the flexibility to be able to work any of the shift times within those hours. Actual shift assignments will not be determined prior to hire. The Claims Examiner also:

Key Responsibilities
Reviews claims and extracts information for processing
A portion of the day will be staffed to an incoming call line in order to assist beneficiaries and family members with questions and claim status
Be flexible and available for evening phone coverage on a rotating basis
Collects and processes death and life disability waiver claims
Verifies, corrects, and completes claims information by telephone, letter, or personal contact
Conducts investigations and gathers supporting documentation on claims
Calculates benefits payable
Approves (to a specified amount) or denies claims in accordance with established procedures

Qualifications:
The characteristics below describe our ideal candidate

Entrepreneurial Mindset
Future State Vision, Present Day Action – Able to keep the long run goals in sight while tackling and overcoming the day-to-day deliverables and challenges.
Creative Problem Solver – Evaluates situations from all angles, does not shy away from out of the box solutions that have not been attempted before.
Motivated Self Starter – Enthusiastic about tackling challenges and leads the way on getting the ball rolling.

Versatile Communicator and Collaborator
Flexible and Adaptable – Able to flex their style of communication and find new ways to partner to build a cohesive team and maintain progress.
High Awareness – Understands how different individuals and groups will react to changes and anticipates future.
Persuasive – Able to get team members and business partners on board with the vision and execution of transformation objectives.

Intelligent Risk Taker and Decision Maker
Intelligent Risk Taker – Evaluates situations, understands the challenges, takes the necessary risks to get tasks completed.
Decisive — Can make decisions that will be instrumental in moving work forward.
Takes Ownership – Takes responsibility for ones work as if it was their own business.

Low Ego Leadership
Authentic, Thoughtful, Fair, and High Integrity – Treats everyone as equal, listens to different perspectives, and establishes an inclusive environment.
Optimistic — Remains positive and inspiring during difficult situations and drives others to be a part of the solution.
Embraces Humility — Understands that this job is not about knowing the right answer, its about finding the right answer.

We also prefer:
Bachelors degree or equivalent years of industry experience preferred
Working knowledge of Life or Disability Claims is a plus

Additional Information:
This position will work virtually, therefore new hires must be able to provide the following:
Subscribe to internet service provider plan with at least 25 Mbps download speeds. You must be willing to troubleshoot any issues or outages with your home internet service, contacting your service provider as necessary. Wired Ethernet (connected into router or Wi-Fi extender or MESH), NOT connecting computer over Wi-Fi.
Use of USB wired headset with a noise cancellation feature (required for all CSPs, optimal for all other roles)
Must have the capability to handle calls with a cell phone (would need to have unlimited data and minutes) or a landline.  Your personal phone number will not be identified to customers.
Quiet area in your home with minimal distractions and noise free.
Reliability and Dependability throughout our extensive training program is required

What we offer you:
Market driven base salaries, with a yearly bonus potential at every level
Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave.
Retirement plans: 401(k) plan with company match (up to 4%)
Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
Tuition Assistance to help finance traditional college enrollment toward obtaining an approved degree, many accredited certificate programs, and industry designations.

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Note: Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $39,400.00 to $58,500.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills. Roles may also be eligible for additional compensation and/or benefits. Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. In addition, employees are eligible for standard benefits package including paid time off, medical, dental and retirement.

Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom.

Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status , medical condition or any other characteristic protected by law.