Job Title: Claims Examiner-Contestable

Location: GPM Life Insurance, San Antonio, TX

Working Conditions: In - Office, (NOT remote)

Job Type: Full-Time

ABOUT GPM LIFE INSURANCE

GPM Life is a Northeast San Antonio based life insurance company with an emphasis on providing excellent customer service to policyholders/customers, agents, and the GPM Life team.

GPM Life offers a competitive benefits package including medical, dental, vision, group life insurance, and a 401(k) plan with a company match.

GPM Life employees work 39 hours/week Monday through Friday. (Friday-employees work 5 hours.)

REQUIRED SKILLS ****

• Minimum of 2 years administrative experience.
• Excellent customer service and listening skills.
• Strong computer skills to include Word and Excel.
• Proficiency in math or accounting.
• Must be able to show empathy to customers.
• Must interact well with others.
• Must be able to work in a fast-paced environment.
• Ability to prioritize and multi-task.

ABOUT THE POSITION

This position is an entry level position in the Claims department. The Claims Examiner-Contestable is responsible for the review, processing, and payment of life insurance death claims or annuity death claims for policies that were issued less than two years ago. The examiner is responsible for ensuring compliance with company policies and state laws.

Job duties/responsibilities:

• Set up contestable death claims for GPM Life, GPM H&L, and Accelerated Living Benefit Rider (ALBR) claims.
• Performs investigation on all contestable life and ALBR claims to include requests of all medical records that pre-date the application, runs, MIB and ScriptCheck as well as criminal and driving records.
• Submits file with all investigative records to the Senior Underwriter for review for material misrepresentation when application was submitted.
• If no material misrepresentation is found, submits file to Sr Claims Specialist for approval. Request claims checks. After claim approval, another Claims Examiner handles the closing of the claim file, which includes the mailing of claim checks to the appropriate party(ies). Handles any work that needs to be completed on cross referenced files of death claims (i.e., change of beneficiary, mode change, etc.). Prepares closed claim files for imaging.
• If evidence of material misrepresentation is found, send the file to the VP- Claims and Records for determination of claim denial or recission.
• Handles annuity claims to include options available to beneficiary for taxation of annuity proceeds (i.e., spousal rollover, 5-year annuity rate, life income options).
• Requests reinsurance reimbursement on the appropriate death claim and ALBR files. Prepares necessary forms, follows up on reinsurance payment, and submits reinsurance payment to Accounting, and prepares accounting entries. Updates Excel files for Claim logs.
• Handles GPM H&L contestable death claims to include manual calculations for outstanding policy loans, unearned premiums, and death claim interest.
• Prepares Supplemental Contracts options elected by claimants for death claim proceeds. Request check(s) for initial payment needed under specific options(s). Prepares payout or other information needed for Accounting to maintain funds or to make periodic payments.
• Receives and handles telephone calls from agents, policyholders, beneficiaries, funeral homes, and vendors/providers for pending death claims. Assists the beneficiary with the handling of requests for change of beneficiary, owner, change of name, or change of premium information on cross referenced policies.
• Searches for possible death claims through the various state locator services.
• Assists in locating deceased insureds and family members resulting from matches through Social Security Death Master List.
• Reports directly to Vice President-Claims and Records and assists in various miscellaneous duties, including preparing internal and external reports, gathering information for studies, and other special projects.
• Performs other duties as assigned.

CANDIDATES SHOULD HAVE

• Proficient computer skills including Word and Excel experience.
• Strict attention to detail in all work completed.
• Strict adherence to confidentiality and privacy rules is required.
• Effective communication and customer service skills.
• Time management and organizational skills.
• Great people skills.
• Professional demeanor.

EDUCATION AND EXPERIENCE:

• High School plus some college or equivalent.
• Minimum of 2 years customer service experience.
• Experience in a life insurance environment preferred.
• Must have accurate data entry skills.