Senior Life Policy Claims Specialist

Description:

We are seeking an experienced Senior Life Policy Claims Specialist to oversee the assessment, review, and administration of life insurance claims. The successful candidate will evaluate policy coverage, verify beneficiary information, review supporting documentation, investigate complex claims, and coordinate the timely resolution of death, terminal illness, critical illness, and other life policy benefit claims.

This fully remote role requires strong knowledge of life insurance policy provisions, claims adjudication, beneficiary verification, documentation standards, and regulatory compliance. You will work closely with policy administration teams, underwriting, legal, compliance, medical reviewers, beneficiaries, and external service providers to ensure claims are handled accurately, fairly, and confidentially.

Key Responsibilities

• Review and assess life insurance claims in accordance with policy terms, conditions, exclusions, and applicable procedures.
• Evaluate death claims, terminal illness claims, critical illness claims, and other covered life policy benefits.
• Verify policy status, coverage validity, premium payment history, waiting periods, and applicable benefit limits.
• Review death certificates, medical reports, beneficiary forms, identity documents, and other supporting evidence.
• Validate beneficiary details, nomination records, assignments, and entitlement documentation.
• Assess policy exclusions, contestability periods, misrepresentation concerns, and relevant policy limitations.
• Coordinate with medical professionals, hospitals, registries, and other authorized parties to obtain additional claim information.
• Investigate complex, high-value, disputed, or potentially fraudulent claims.
• Identify inconsistencies, suspicious documentation, non-disclosure concerns, and unusual claim patterns.
• Coordinate with underwriting teams when reviewing medical history, policy disclosures, and underwriting-related issues.
• Prepare clear claim assessment summaries, decision recommendations, and supporting documentation.
• Monitor claims processing timelines and ensure cases are progressed within agreed service-level standards.
• Manage escalated beneficiary and policyholder queries with professionalism and sensitivity.
• Coordinate payment preparation and settlement documentation with authorized finance and payment teams.
• Review declined, postponed, and referred claims to ensure decisions are supported by policy provisions and evidence.
• Maintain accurate claims records, case notes, correspondence, and audit trails.
• Ensure confidential personal, financial, and medical information is handled securely.
• Support internal audits, regulatory reviews, and claims quality assurance activities.
• Monitor changes in life insurance regulations, claims practices, and industry standards.
• Recommend improvements to claims workflows, documentation requirements, and operational controls.

Qualifications and Experience

• Bachelor's degree in Insurance, Finance, Business Administration, Risk Management, Law, or a related discipline.
• Significant experience in life insurance claims assessment, policy administration, or insurance operations.
• Strong understanding of life insurance products, policy provisions, exclusions, and benefit structures.
• Experience handling death, terminal illness, critical illness, and other life policy claims.
• Knowledge of beneficiary verification, nomination procedures, assignments, and settlement requirements.
• Ability to interpret policy wording and assess claims against contractual terms and conditions.
• Experience reviewing medical records, death certificates, and other sensitive supporting documentation.
• Understanding of underwriting principles, policy disclosure requirements, and contestability provisions.
• Familiarity with insurance fraud indicators, investigation procedures, and escalation protocols.
• Knowledge of applicable insurance regulations, privacy requirements, and claims handling standards.
• Experience with claims management platforms and insurance administration systems.
• Strong analytical skills and sound judgment when reviewing complex claims.
• Excellent written communication and technical report-writing abilities.
• High attention to detail and strong document verification skills.
• Ability to handle sensitive and emotionally difficult cases with empathy and professionalism.
• Proficiency in Microsoft Office and claims reporting tools.
• Ability to manage multiple cases and meet strict processing deadlines.
• Relevant insurance qualifications, such as CII or other recognized life insurance certifications, are desirable.