Waiver of Premium Claims Specialist

About the Job:

Analyzes eligibility for newly requested, complex Waiver of Premium Benefits by investigating, analyzing, and approving or denying Waiver of Premium claims, and approving or denying Waiver of Premium Benefits on active claims. Uses extensive medical, legal, policy and claim knowledge to interpret and analyze pertinent facts to reach claim decisions.

What You'll Do:

• Investigates, analyzes and approves or denies complex contestable and non-contestable Waiver of Premium claims, including, but not limited to those for unemployed, retired, homemaker, child, late, no liability, Financial Representative, and terminated policies. Uses extensive medical, legal, policy and claims knowledge in interpreting and analyzing pertinent facts to reach claim decisions consistent with our claim philosophy.
• Orders and reviews appropriate medical, investigative, and other information needed to determine the eligibility of claims.
• Manages claim files actively by evaluating claim information and making decisions regarding approval, denial, continuing benefits, and terminations on a regular, ongoing basis.
• Communicates verbally and in writing with Insureds, field force, medical practitioners and related facilities, attorneys, other insurance companies, appointed representatives, employers, government agencies and divisional resources involving negotiation and conflict resolution.
• Preserves Northwestern Mutual's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.
• As part of the claim handling process, may be called upon to represent the Company in legal matters through preparation for and participation in depositions and trials.
• Actively participates in committee and project work, based on business need.
• Signature Limits : WP $0 - $60,000

What You'll Bring to the Role:

• Bachelor's degree or equivalent combination of education and progressively responsible work experience, preferably in the area of health care, business, insurance, law, or communication
• Knowledge of medical terminology as well as experience with insurance contracts and field servicing preferred
• One to three years of responsible and relevant work experience demonstrating analytical ability, independent decision-making and sound judgment in the application of guidelines
• Strong analytical skills that ensure a fair and consistent decision-making process
• Superior organizational and time management skills
• Customer-centric communication, both written and verbal, with a focus on our policyowners and field force
• High degree of self-motivation and initiative in taking responsibility for own work while contributing to team goals; able to collaborate within and across teams to obtain the best possible result
• Experience handling Waiver of Premium and/or Disability Income claims preferred
• Experience working with claim management systems such as DI Benefits Connection and Claims Platform

Skills you have:

• Claims Acumen- Applies knowledge of claims philosophy, contracts, and policies and procedures for filing claims, assessing claims for accuracy and completeness, verifying eligibility, and adjudicating claims based on established criteria. Evaluates medical, financial, and occupational information to determine whether the insured meets contractual provisions, considering applicable state regulations and other relevant contractual information. Analyzes insurance claims to determine claim validity, risk, and extent of coverage.
• Insurance Contract Management- Addresses specialty product and regulatory elements of policy terms and conditions. Manages claims processing, compliance, and customer service to ensure the policy aligns with the policyholder’s needs and expectations.
• Analytical Thinking- Organizes and compares various aspects of a situation to understand and identify key or underlying complex issues through quantitative data and analysis. Leverages business acumen, problem-solving, and interpersonal skills to think critically about situations from multiple perspectives and consistently seeks ways to improve processes.
• Attention to Detail- Focuses on specific details to identify and correct errors before they are found and to exceed quality expectations. Performs work with thorough proofreading for presentation, content, accuracy, and overall quality.
• Empathetic Communication- Empathizes and relates to clients navigating difficult life situations. Handles cases with care and compassion. Practices active listening to understand each customer’s unique needs and make more informed decisions about their policies.
• Information Gathering- Gathers quality information from a diverse set of sources, using the appropriate collection technique for a variety of applications.
• Decision Making- Makes timely, data-driven decisions by understanding the probability of success, identifying risks, gathering business requirements, and developing value statements.

#LI-Hybrid

Compensation Range:

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We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, click here to learn more.

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Northwestern Mutual is an equal opportunity employer that welcomes talented individuals of all backgrounds. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.