Manager, Life & Complex Claims

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct secondary reviews and grant financial approvals for life claims, investigations involving contestable claims, policy rescissions, and claims related to living benefit riders.

• Oversee comprehensive medical investigations throughout the contestability phase.

• Facilitate weekly Complex Claims Roundtables in collaboration with Underwriting, Legal, and Compliance teams.

• Act as the main point of escalation for intricate claims, appeals, contested denials, and inquiries from regulatory bodies.

• Coordinate workflows with IME providers, FCE vendors, retrieval services, investigation partners, and reinsurers.

• Guide and enhance the skills of specialized examiners in investigative methods, medical record evaluation, fraud detection, policy provisions, and claims expertise.

• Establish and track performance metrics through one-on-one meetings, development initiatives, and corrective action plans.

• Oversee workload distribution and queue management to ensure compliance with Service Level Agreements (SLAs) and to prevent aged inventory.

• Assess workflows, correspondence, and forms to shorten cycle times and enhance the customer experience.

• Supervise Standard Operating Procedures (SOPs), job aids, and training documentation pertinent to life, living benefit, and complex claim adjudication.

• Leverage claims data and Business Intelligence dashboards to pinpoint delays, identify quality trends, and recognize fraud patterns.

• Manage life and complex claims operations while ensuring adherence to state and industry regulations.

• Oversee quality assurance, claims governance, authority levels, escalation procedures, and risk management strategies.

• Develop team performance, cultivate talent, and promote team engagement and effectiveness.

⛳️ Requirements

• Minimum of 5 years of relevant experience.

• At least 5 years of progressive experience in claims adjudication related to Life, Disability, Contestable claims, and/or Living Benefit Riders.

• A minimum of 2 years in a direct leadership role or demonstrated technical supervisory/mentorship experience in a specialized claims setting.

• Bachelor's degree is preferred, or equivalent professional experience is acceptable.

• A combination of education and experience may be considered in lieu of a degree.

• Professional designations from LOMA (e.g., FLMI, ALMI) or the International Claim Association (ICA) (e.g., FLHC) are preferred.

• Familiarity with Lean, Six Sigma, or continuous process improvement methodologies is preferred.

• Strong expertise in life and/or disability claims, particularly in contestable and accelerated benefit claims.

• Knowledge of state contestability statutes, regulations on unfair claims settlement practices, HIPAA standards, and policy rider language.

• Ability to analyze medical records, legal documents, trust agreements, and historical application data.

• Up-to-date knowledge of life and annuity regulations, state claims handling requirements, unclaimed property laws, and compliance responsibilities.

• Consistent and punctual attendance.

• Willingness to travel up to 10% of the time.

🏝️ Benefits

• Options for in-office, hybrid, and remote work arrangements, to be determined with the leader during the hiring process.

• Reasonable accommodations provided for applicants and candidates with disabilities.

• Employee-focused flexible/hybrid work environment.