Accidental Benefit Representative

Job Description

We are seeking a detail-oriented and compassionate Accidental Benefit Representative to manage, process, and support claims related to accidental injury or death benefits. This role is responsible for ensuring beneficiaries and policyholders receive accurate information and timely assistance during claim processes, while maintaining compliance with company policies and legal requirements.

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Key Responsibilities:

• Serve as the primary point of contact for individuals filing accidental benefit claims.
• Review, process, and verify documentation for accidental death and dismemberment (AD&D) claims.
• Assist policyholders or employees in completing and submitting claim forms.
• Communicate claim decisions and explain benefits coverage in a clear, empathetic manner.
• Liaise with internal departments (e.g., underwriting, legal, HR) and external partners (e.g., healthcare providers, legal representatives) to gather necessary information.
• Maintain detailed and confidential records of all claims interactions and documentation.
• Ensure claims are processed in accordance with applicable policies, procedures, and legal regulations.
• Provide ongoing updates to claimants regarding the status of their applications.
• Identify and escalate complex cases or discrepancies to senior staff or supervisors.
• Educate claimants and stakeholders on plan features, coverage limitations, and appeal processes.

Qualifications:

• Bachelor’s degree in Business, Insurance, Healthcare Administration, or related field (preferred).
• 1–3 years of experience in insurance claims, employee benefits, or customer service (accidental or life insurance experience is a plus).
• Strong knowledge of accidental death and dismemberment insurance and employee benefits plans.
• Excellent communication and interpersonal skills.
• High level of accuracy, discretion, and attention to detail.
• Proficient with MS Office and claims management systems.
• Ability to handle sensitive and emotional situations professionally.

Preferred Skills:

• Familiarity with HIPAA and data privacy regulations.
• Bilingual capabilities are an asset.
• Experience in a healthcare or legal support environment.

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