Sr Associate, Claim Representative - Operations

This role ensures timely and accurate processing of claims, supports internal and external audits, and contributes to operational efficiency. The Sr. Associate works cross-functionally to resolve issues and maintain high standards of data integrity and client service. In addition, this role provides day‑to‑day oversight of the document function, including Document Capture and Document Indexing, ensuring that document workflows, quality assurance, and processing standards are consistently met. The Sr. Associate partners closely with document operations staff, providing guidance, identifying issues, and ensuring readiness for downstream claim processing.

Claim Representative

• Perform adjudication of life claims for assigned clients, including standard and contestable cases.
• Review claim documentation such as death certificates, claimant statements, and policy records to verify eligibility.
• Assess claim validity based on treaty terms, policy provisions, and underwriting guidelines.
• Assist with performance of client adjudication audits for assigned clients to ensure compliance with treaty terms and adjudication standards.
• Serve as liaison to clients for claim-related inquiries
• Review and approve claims in accordance with claim payment approval hierarchy.
• Review, enhance, and sign settlements to ensure timely client payments
• Process claim refunds appropriately and timely.
• Monitor workflow and identify potential claims processing issues.
• Work cross-functionally to resolve system impediments to claim payment processing.
• Identify opportunities for improvement and contribute to process enhancements.
• Assist with internal and external audits and ensure all ICS controls are properly documented.
• Establish requirements for system enhancements and log tickets for tracking, UAT testing, and implementation.
• Creation and maintenance of reports allowing for analysis of claim workflow and data fields to ensure accuracy of claim data. 
• Analyze client trending data to understand financial results and identify potential future impact.
• Produce ad-hoc reports and claims metrics for management and other stakeholders.
• Perform monthly and quarterly reporting requirements for performance measurement and to meet quarter end deliverables.
• May perform other duties as required.

Document Capture and Indexing Oversight

• Provide functional guidance, without direct supervisory authority, to Document Capture and Indexing staff to ensure compliance with procedures and quality standards.
• Act as the first point of support when issues related to documents, workflow, AIssistant implementation occurs.
• Monitor document workflow and escalate systemic issues, volume concerns, and recurring quality defects.
• Communicate expectations, process clarifications, and system changes affecting document operations.
• Serve as a subject‑matter resource for document processing questions from internal teams.
• Collaborate with document representatives to improve consistency, reduce rework, and strengthen data integrity.