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Symetra · 1 month ago

Claims Examiner

USA

Full-time

Hybrid

Mid Level

$24.62/hr - $41.04/hr

Symetra is a national financial services company dedicated to helping people achieve their financial goals. The Claims Examiner role is responsible for the timely adjudication of group life and AD&D claims, ensuring accurate payments to beneficiaries while providing world-class service to customers.

Financial ServicesHealth InsuranceInsuranceLife Insurance

Growth Opportunities

No H1B

Responsibilities

Reviews, investigates and determines eligibility pursuant to policy provisions while meeting regulatory, statutory, department and company requirements

Requires ability to appropriately interpret and apply contract provisions. Reaches out to the policyholder and beneficiaries regarding outstanding requirements

Consults with manager regarding potential referrals to Legal Department and medical resources when needed

Maintains claim records and documents claims in a manner defensible in court. Communicates claim status and decisions to policyholders, insureds, beneficiaries and other interested parties in accordance with internal guidelines, regulatory and statutory requirements. Demonstrate proficient use of the claim system and associated systems

Maintains performance at or above departmental metrics. Determines correct payee and accurately issues payments with next level approvals

Educates and coaches the policyholder, brokers/agents and internal Symetra partners on proper policy administration when needed

Identify issues and take ownership of problems. Find solutions and see them through to resolution

Has flexibility, collaboration and support for a positive work environment both within the team and across all departments

Be an active agent for change and identify opportunities within our processes and procedures to improve

Qualification

Claims adjudicationPolicy interpretationClaim system proficiencyRegulatory complianceCustomer serviceProblem-solvingCollaborationFlexibility

Required

Responsible for timely adjudication of group life and AD&D claims, verifying eligibility and making the initial claim decision based on the policy

Responsible for making accurate payments to the correct beneficiaries

Strong desire to provide world class service to both internal and external customers

Reviews, investigates and determines eligibility pursuant to policy provisions while meeting regulatory, statutory, department and company requirements

Requires ability to appropriately interpret and apply contract provisions

Reaches out to the policyholder and beneficiaries regarding outstanding requirements

Consults with manager regarding potential referrals to Legal Department and medical resources when needed

Maintains claim records and documents claims in a manner defensible in court

Communicates claim status and decisions to policyholders, insureds, beneficiaries and other interested parties in accordance with internal guidelines, regulatory and statutory requirements

Demonstrate proficient use of the claim system and associated systems

Maintains performance at or above departmental metrics

Determines correct payee and accurately issues payments with next level approvals

Educates and coaches the policyholder, brokers/agents and internal Symetra partners on proper policy administration when needed

Identify issues and take ownership of problems

Find solutions and see them through to resolution

Has flexibility, collaboration and support for a positive work environment both within the team and across all departments

Be an active agent for change and identify opportunities within our processes and procedures to improve

Employer work visa sponsorship and support are not provided for this role

Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company

Minimum Internet Speed: 100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of 'broadband.'

Internet Type: Fiber, Cable (e.g., Comcast, Spectrum), or DSL

Not Permissible: Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up

Candidates will be required (after the initial phone screen) to be on video for all interviews