Final Expense Contestable Claims Examiner

Description

Final Expense Contestable Claims Examiner

Continental General - Austin, Texas

Looking to join a growing company dedicated to helping others? We offer that, plus competitive salaries, a culture of learning, and a fast-paced environment. Join our team to help make a difference in the lives of others! 

About Continental General:

The Continental General family of companies has provided insurance, including life and long-term care policies, to individuals and groups for over 30 years, and currently supports over 100,000 policyholders. Both our insurance company, Continental General Insurance Company, and our third-party administrator, Continental General Services, are committed to the continuous development of our infrastructure, processes, and people. The group is actively growing through expansion of both its insurance portfolio and its administrative services. With each opportunity, we take a collaborative approach to address challenges and provide unique solutions.

Position Overview:

The Final Expense Contestable Claims Examiner is responsible for evaluating and adjudicating life insurance claims that fall within the contestable period. This role ensures the integrity of the claims process by conducting thorough investigations, reviewing medical records and application information, and determining claim eligibility in accordance with policy provisions and regulatory requirements.

Key Responsibilities:

• Investigate and analyze final expense claims within the contestable period to detect misrepresentation, fraud, or discrepancies.
• Obtain and review medical records, attending physician statements, coroner’s reports, and other relevant documents to assess validity of claims.
• Compare the information provided on the application with data gathered during the investigation.
• Collaborate with underwriters, legal counsel, special investigations unit (SIU), and third-party vendors when necessary.
• Determine appropriate claim decisions—approve, deny, or refer to senior leadership—based on findings.
• Communicate decisions clearly and professionally to beneficiaries, agents, and internal teams.
• Maintain accurate and timely documentation of claim files and investigation processes.
• Adhere to state regulatory requirements and internal company guidelines.
• Participate in training, audits, and continuous improvement efforts to optimize claim processes.

Work Environment:

• Fast-paced and deadline-driven environment.
• May involve extended screen time and complex case reviews.
• Ability to manage multiple claim files and priorities simultaneously.

Qualifications

Qualifications:

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• 5+ years of experience in life insurance claims examination, preferably with final expense or contestable claims.
• Familiarity with HIPAA regulations and medical terminology strongly preferred.
• Strong analytical and investigative skills.
• Excellent written and verbal communication skills.
• Ability to handle sensitive information with integrity and confidentiality.
• Detail-oriented with strong organizational skills.
• Proficiency with claims systems, Microsoft Office Suite, and document management tools.

Preferred Qualifications:

• Experience working with third-party vendors for medical record retrieval and contestable investigations.
• Knowledge of life insurance policy structures and underwriting practices.
• Certification in Claims (e.g., LOMA, ICA, ALHC) a plus.

Why Join Us?

• Opportunity to directly drive to growth and scale efforts at a dynamic and innovative company.
• Competitive salary and benefits
• Collaborative and fast-paced work environment.
• Professional development and growth opportunities within the insurance space.

Benefits:

• Competitive Salary & Target Bonus Program
• Retirement Savings – 401(k) with a company match
• Comprehensive Medical insurance through BlueCross BlueShield of Texas. Company-paid dental, vision, short-term & long-term disability, and life insurance.
• Work-Life Balance – This role offers 25 days of PTO, 10 paid holidays, and paid volunteer time off.
• Flexible Work Options & Perks – Hybrid opportunity, wellness programs, and weekly paid lunch for onsite staff.
• Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) – Includes a company match for HSAs.