FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in life and disability claims adjudication, with a strong focus on compliance with state regulations and continuous process improvement methodologies. Proven ability to lead teams, mentor specialized examiners, and manage complex claims workflows effectively.
Highest-signal resume keywords
Claims Adjudication ExperiencePeople LeadershipProcess Improvement MethodologiesLife and Disability Claim ExpertiseRegulatory Compliance Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Data AnalysisMedical Record SynthesisFraud Detection TechniquesPerformance Metrics MonitoringWorkflow EvaluationSOP DevelopmentClaims GovernanceRisk MitigationQueue SegmentationCustomer Experience Improvement
Soft Skills
MentoringTeam EngagementCommunicationProblem-SolvingLeadership
Tools & Technologies
Business Intelligence DashboardsClaims Management SystemsPerformance Tracking Tools
Certifications & Qualifications
FLMIALMIFLHC
Industry Keywords
Life ClaimsDisability ClaimsContestable ClaimsLiving Benefit RidersState Contestability StatutesHIPAA StandardsUnfair Claims Settlement PracticesContinuous Process ImprovementClaims Handling RequirementsUnclaimed Property Laws
About the role
Key responsibilities & impact- Provide secondary review and financial approval for life claims, contestable investigations, policy rescissions, and living benefit rider claims
- Direct end-to-end medical investigations during the contestability period
- Lead weekly Complex Claims Roundtables with Underwriting, Legal, and Compliance
- Serve as the primary escalation point for complex claims, appeals, contested denials, and regulatory inquiries
- Manage workflows with IME providers, FCE vendors, retrieval services, investigation partners, and reinsurers
- Mentor and upskill specialized examiners in investigative techniques, medical record analysis, fraud indicators, policy provisions, and claims skills
- Establish and monitor performance metrics through 1:1s, development plans, and corrective action
- Manage workload allocation and queue segmentation to maintain SLA compliance and prevent aged inventory
- Evaluate workflows, letters, and forms to reduce cycle times and improve customer experience
- Oversee SOPs, job aids, and training documentation for life, living benefit, and complex claim adjudication
- Use claims data and Business Intelligence dashboards to identify delays, quality trends, and fraud patterns
- Oversee life and complex Claims functions and ensure compliance with state and industry regulations
- Oversee quality review, claims governance, authority levels, escalation protocols, and risk mitigation
- Manage performance, develop talent, and support team engagement and effectiveness
Requirements
What you’ll need- 5+ years of relevant experience
- 5+ years of progressive claims adjudication experience in Life, Disability, Contestable, and/or Living Benefit Riders Claims
- 2+ years of direct people leadership or proven technical supervisory/mentorship experience within a specialized claims environment
- Bachelor's degree preferred or equivalent professional experience
- Combination of education and experience considered in lieu of degree
- Professional designations through LOMA (e.g., FLMI, ALMI) or the International Claim Association (ICA) (e.g., FLHC) preferred
- Experience in Lean, Six Sigma, or continuous process improvement methodologies preferred
- Strong life and/or disability claim expertise, with in-depth knowledge of contestable and accelerated benefit claims
- Experience with state contestability statutes, unfair claims settlement practices regulations, HIPAA standards, and policy rider language
- Ability to synthesize medical records, legal documents, trust agreements, and historical application data
- Current knowledge of life and annuity regulations, state claims handling requirements, unclaimed property laws, and compliance obligations
- Regular and punctual attendance
- Ability to travel up to 10% of the time
Benefits
Comp & perks- Ability for in-office, hybrid and remote work arrangements, decided with the leader during the hiring process
- Reasonable accommodations for applicants and candidates with disabilities
- Employee-centric flexible/hybrid work environment