Senior Claims Specialist: Adjudicate with Precision & Care

nationallifeinsurancecompany; Addison (TX); On-site; USD 42,000 - 71,000; Full time

Job summary

National Life Group in Addison, TX is hiring a Sr. Claims Specialist to review, analyze, and adjudicate claims with accuracy and compassion under general supervision. You will determine eligibility, resolve issues, and deliver timely outcomes to policyholders while protecting the company’s financial strength.

The role offers onsite work four days per week. Join a team focused on continuous improvement, collaborating with internal and external partners, maintaining compliance with policies and

Qualifications

• Bachelor's degree in business, finance, insurance, health sciences, or a related field.
• Ability to analyze information, apply sound judgment, and make informed decisions in moderately complex situations.
• Strong attention to detail and effective conflict resolution, business writing, and problem-solving skills.
• Ability to manage multiple priorities, maintain organization, and meet deadlines in a fast-paced environment.

Responsibilities

• Review and verify claim submissions for completeness, accuracy, and required documentation.
• Analyze and adjudicate claims by applying policy provisions, company guidelines, and regulatory requirements.
• Identify discrepancies, investigate issues, and determine appropriate resolutions with limited guidance.
• Document case details thoroughly and accurately in claims systems to ensure timely processing and benefit payment.
• Communicate with claimants, beneficiaries, agents, and internal partners by phone, email, or mail to gather information, explain claim decisions, and provide updates.
• Resolve claims-related questions using sound judgment and established guidelines.
• Manage a caseload of claims appropriate to training level, ensuring effective organization and timely follow-up.
• Recognize trends or recurring issues and escalate appropriately to leadership.
• Participate in ongoing training to maintain and expand knowledge of claims processes, tools, systems, and insurance products.

Skills

Analytical thinking

Decision making

Customer service

Communication skills

Conflict resolution

Organization

Education

Bachelor's degree in business, finance, insurance, health sciences, or related field

Job description

National Life Group in Addison, TX is hiring a Sr. Claims Specialist to review, analyze, and adjudicate claims with accuracy and compassion under general supervision. You will determine eligibility, resolve issues, and deliver timely outcomes to policyholders while protecting the company’s financial strength.

The role offers onsite work four days per week. Join a team focused on continuous improvement, collaborating with internal and external partners, maintaining compliance with policies and