Life Claims Assessor
Core
Assess and manage Group Life, AD&D, Survivor Income, and Compassionate Assistance Program claims by reviewing coverage, eligibility, documentation, and contract provisions to determine outcomes and calculate benefits.
Role type
Life Claims Assessor
Builds
Claim decisions and benefit payments for group clients and beneficiaries
Domain
Insurance / Group Benefits
Deliverable
client delivery
Required skills
Insurance claims assessment, contract provision interpretation, benefit calculation, medical terminology knowledge, documentation review, beneficiary validation, regulatory compliance
Preferred skills
Bilingual English/French, experience in Group Benefits or Life/Disability claims
Technologies
Microsoft Office (Outlook, Teams, Word, Excel)
Responsibilities
Review plan member and dependent coverage to confirm eligibility; Interpret and verify contract provisions applicable to each claim; Validate enrolment details and beneficiary information; Review proof-of-death documentation and supporting reports; Calculate eligible benefits accurately; Prepare and maintain claims system records; Communicate claim decisions to claimants and beneficiaries; Assist plan sponsors with claim submission requirements
Seniority
Individual Contributor