Senior Claims Adjudicator
Newtown, TT
POSITION SUMMARY
Responsible for the adjudication of risk claims: (death claims, disability/waiver claims, critical Illness, Accidental death/ dismemberment). He/ She is responsible for the review and authorization of complex claims in line with the established best practice, company guidelines and authorization limits and based on expert advice received from relevant experts.
KEY ACCOUNTABILITIES
- Assessment and Determination of complex risk claims (Death, Critical Illness claims, Disability Income and Waiver of Premium as well as Accidental Indemnity Rider and documentation of key information supporting the decision
- Utilize expert opinion from the following where applicable to assist in the determination of the claims. These include but are not limited to the Chief Medical Officer or other medical professionals, Chief Financial Officer, Chief Underwriter, Legal Officer and investigators or any other expert.
- Refer claims that require special consideration to the Claims Committee including the summary of the claim, rational for referral, the recommended decision and relevant supporting documentation. To action outcome of the Committee decision.
- Verify and authorize claims and refund payments and approve Payment Request Vouchers within authorized limits.
- Knowledge of all relevant documents, Treaties and Acts which impact the death claims process and function as liaison with the reinsurers in matters impacting claims.
EDUCATION & QUALIFICATIONS
- A First Degree in Business, Insurance or relevant field
- 5 CXC ‘O’ Levels, including Mathematics and English
- 2 A’ Level/ CAPE passes
- LOMA diploma – FLMI / ACS
- ICA or Associate, Life and Health Claims Program (ALHC)
EXPERIENCE
At least 3-4 years’ experience in a Customer Service / Underwriting / Claims Environment in the financial services industry inclusive of at least two years at a supervisory Level. In depth knowledge of Products and Contracts of TATIL Life