Claims Associate I

Kansas City Life Insurance; Missouri; On-site; USD 65,000 - 90,000; Full time

Job summary

Kansas City Life Insurance Company is seeking an experienced Insurance Claims Examiner in Missouri. The role analyses claims, assesses eligibility, and ensures timely, fair payments while maintaining strong customer service and compliance with policy provisions.

The position emphasizes collaboration with underwriters, legal, and investigation teams to resolve complex claims. The ideal candidate will have a bachelor’s degree in a business-related field and at least four years of claims

Qualifications

• Bachelor’s degree or equivalent work experience in a business-related field.
• At least 4 years of practical insurance claim experience.
• Ability to communicate clearly with customers and internal stakeholders.
• Familiar with corporate multiline products, procedures, and practices.

Responsibilities

• Analyze claims and determine validity based on policy provisions, riders, waivers and state regulations.
• Provide superior customer service to claimants and prepare related forms as applicable.
• Maintain knowledge of adjudication and reporting responsibilities within the department.
• Order investigations on complex claims and coordinate with investigations and reinsurance when needed.
• Review medical information to approve or deny benefits and process payments accordingly.
• Approve and request claim expense checks for outside investigations and fees.
• Expand knowledge of anatomy, physiology, and medical practices to inform claims decisions.
• Spot red flags for potential fraud and consult with Legal as needed.

Skills

Insurance claims experience

Communication skills

Decision making

Analytical thinking

Education

Bachelor's degree in business-related field

Tools

Windows applications

Job description

Job Description

QUALIFICATIONS/REQUIREMENTS:

• Bachelor of Arts or Sciences degree in a business-related field or equivalent work experience.
• At least 4 years of practical insurance claim experience.
• Ability to use resources effectively, exercise good judgment, make decisions, and apply knowledge and experience to related situations to allow many types of requests to be handled independently.
• Ability to professionally interact with business people of all levels and succinctly communicate information to internal and external customers.
• General understanding of corporate multiline products, procedures, and practices.
• Demonstrated knowledge of company administrative systems and software. Familiarity with PC and Windows applications, including the ability to learn new and complex computer system applications.

DUTIES/RESPONSIBILITIES:

• Analyze claims and determine their validity based on policy provisions, riders, waivers, operating procedures, and state regulations. Calculate benefits payable and interest due. Ensure claims are paid in a prompt and equitable manner or decline payment for losses that are not covered.
• Provide superior customer service to claimants or their representatives. Prepare tax forms, state notice forms, and state consent forms when applicable.
• Maintain working knowledge of adjudication and reporting responsibilities within department and provide assistance to other examiners to ensure claims are handled in a timely manner.
• Order investigations on suicide, homicide, and accidental death claims. Investigate abandoned property cases. Administer reinsurance reporting and communication and assure proper reconciliation.
• Determine from medical records received, approval or denial of contestable claims; request medical information from doctors and hospitals as needed. Upon receipt, review and determine whether benefits are applicable and pay or deny claims.
• Approve and request claim expense checks for outside investigations and attorney’s fees.
• Continually expand knowledge of human anatomy, physiology, disease processes, and medical practices and procedures, and consult with Underwriting or Medical Director as needed.
• Continually expand knowledge of legal decisions, opinions, proper practices, and procedures, and consult with Legal department as needed. Alert to spot red flags for potential fraud instances.

Regular and reliable attendance and punctuality is an essential function of this position.

Kansas City Life Insurance Company is committed to equal employment opportunities for all individuals regardless of race, religion, color, sex, age, national origin, disability, or genetic information.

Company Description

Kansas City Life Insurance Company was established in 1895 in Kansas City, Mo. Our agency force of more than 2,500 serves 49 states and the District of Columbia. We insure more than half a million policyholders from coast to coast. Our Home Office is located in Kansas City, Mo., with a staff of more than 400 associates who provide support for our field force and policyholders.