Senior Claims Examiner (Virtual)

Job Classification:

Operations - Insurance Operations

At Prudential, we make lives better by solving the financial challenges of our changing world. Bring your experience and unique insights to a collaborative culture focused on meeting our customer needs!

Enabling Solutions is transforming our Enterprise-wide operating model to be a customer-obsessed organization that inspires all our employees to be bold and better in all that we do.

The U.S. Back Office Customer Service (BOCS) organization is seeking a Claims Examiner to join our Group Life Claim Team of Beneficiary Fulfillment on our Specialized Client Concierge Team. Our Concierge Team strives to be customer obsessed by providing a “white glove” service throughout the life of the claim. This involves making outbound calls and providing a proactive approach to bring resolution to each claim. This is a high touch service model where you will be interacting daily with beneficiaries and families during a difficult time of loss. Customer Service skills, Empathy, and a willingness to help others are key skills for a successful candidate in this role.

The successful candidate will be trained to adjudicate life insurance claims for Group Insurance with a focus on accuracy, timeliness, and appropriate decision making. The candidate will also be trained to answer phone calls in order to assist beneficiaries and family members through the claim process. During in-classroom and on-the-job training, the incumbent will learn how to navigate our claim system, learn about our products, policies, and procedures and how to assist our customers at a time of critical need.

The successful candidate will be responsible for effectively adjudicating claims to meet production, quality, and service metrics in accordance with policy/procedures and regulatory guidelines. This entails working with both internal and external partners to obtain information required for claim handling.

Key Responsibilities

• Reviews claims and extracts information for processing

• For a portion of the day will be staffed to an incoming call line in order to assist beneficiaries and family members with questions and claim status

• Be flexible and available for evening phone coverage on a rotating basis

• Collects information and processes death claims

• Verifies, corrects, and completes claims information by telephone, letter, or personal contact

• Conducts investigations and gathers supporting documentation on claims

• Calculates benefits payable

• Approves (to a specified amount) or denies claims in accordance with established procedures

Qualifications
The characteristics below describe our ideal candidate

Entrepreneurial Mindset

• Future State Vision, Present Day Action - Able to keep the long run goals in sight while tackling and overcoming the day-to-day deliverables and challenges.

• Creative Problem Solver - Evaluates situations from all angles, does not shy away from out of the box solutions that have not been attempted before.

• Motivated Self Starter - Enthusiastic about tackling challenges and leads the way on getting the ball rolling.

Versatile Communicator and Collaborator

• Flexible and Adaptable - Able to flex their style of communication and find new ways to partner to build a cohesive team and maintain progress.

• High Awareness - Understands how different individuals and groups will react to changes and anticipates future.

• Persuasive - Able to get team members and business partners on board with the vision and execution of transformation objectives.

Intelligent Risk Taker and Decision Maker

• Intelligent Risk Taker - Evaluates situations, understands the challenges, takes the necessary risks to get tasks completed.

• Decisive – Can make decisions that will be instrumental in moving work forward.

• Takes Ownership - Takes responsibility for one’s work as if it was their own business.

Low Ego Leadership

• Authentic, Thoughtful, Fair, and High Integrity - Treats everyone as equal, listens to different perspectives, and establishes an inclusive environment.

• Optimistic – Remains positive and inspiring during difficult situations and drives others to be a part of the solution.

• Embraces Humility – Understands that this job is not about knowing the right answer, it's about finding the right answer.

We also prefer:

• Bachelor's degree or equivalent years of industry experience preferred

• Working knowledge of Life or Disability Claims is a plus

This position will work virtually, therefore new hires must be able to provide the following & all new hires who work remotely will be held accountable to these standards:

• Subscribe to internet service provider plan with at least 25 Mbps download speeds. You must be willing to troubleshoot any issues or outages with your home internet service, contacting your service provider as necessary.

• Must have the capability to handle calls with a cell phone (would need to have unlimited data and minutes) or a landline. Your personal phone number will not be identified to customers.

• Quiet area in your home with minimal distractions and noise free.

• Reliability and Dependability throughout our extensive training program is required.

What we offer you:

Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $45,700.00 to $75,500.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills.

• Market competitive base salaries, with a yearly bonus potential at every level.
• Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave.
• 401(k) plan with company match (up to 4%).
• Company-funded pension plan.
• Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.
• Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
• Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.
• Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period).

Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week.

Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom.

Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law.

If you need an accommodation to complete the application process, please email [email protected].

If you are experiencing a technical issue with your application or an assessment, please email [email protected] to request assistance.

Originally posted on