Senior Claims Examiner-6

Job Classification:

Operations - Insurance Operations

Annuity Claims Examiner (Remote)

Job Summary

The Annuity Claims Examiner is responsible for end-to-end processing of annuity death claims, ensuring timely, accurate, and compliant benefit payments. This role works in a fast-paced, highly regulated environment and requires strong judgment, attention to detail, and clear, empathetic communication with beneficiaries and advisors. The role also uses technology—including AI tools such as Copilot—to improve productivity, quality, and customer outcomes as processes evolve.

Key Responsibilities

• Process annuity death claims from initial notification through final payment, including beneficiary validation, documentation review, adjudication, and payment authorization
• Validate contract provisions, ownership, beneficiaries, and required documentation to achieve good order
• Determine claim eligibility and settlement options in accordance with policy/contract terms
• Ensure compliance with regulatory, legal, and internal policy requirements, including time-sensitive claim and payment standards
• Request, track, and evaluate outstanding requirements; document pending reasons and next steps clearly
• Process payments, reissues, adjustments, and reversals as needed
• Review and resolve reopens, referrals, and NIGO items in accordance with established adjudication and quality procedures
• Resolve discrepancies, exceptions, and complex claim scenarios; escalate trends/defects/process gaps as appropriate
• Document claim decisions and actions thoroughly in core systems to support downstream processing, reporting, and audit readiness
• Manage assigned workloads using Salesforce-based claims platforms and related systems, prioritizing work to meet service-level and regulatory commitments
• Respond to internal inquiries, advisor questions, and beneficiary escalations
• Meet productivity, quality, and timeliness goals, recognizing expectations may evolve as technology and process improvements are implemented
• Collaborate with Contact Center partners, Operations leaders, Technology teams, external vendors, and other business partners
• Participate in quality reviews, audits, and continuous improvement efforts by identifying inefficiencies, recommending solutions, and adopting new tools and workflows
• Leverage AI tools, including Copilot, to improve efficiency, accuracy, and decision-making
• Demonstrate adaptability and resilience during periods of change, including system migrations, process redesigns, and volume fluctuations

Qualifications

Required Qualifications

• High school diploma or equivalent
• 2+ years of experience in insurance, annuities, claims, or financial services operations
• Strong attention to detail, analytical skills, and sound decision-making
• Ability to interpret contract language and procedural guidelines
• Strong written and verbal communication skills
• Ability to manage multiple claims and deadlines simultaneously
• Proficiency with case management and workflow systems
• Demonstrated adaptability and willingness to work through change

Preferred Qualifications

• Experience with annuity death claims or beneficiary services
• Experience working in Salesforce-based platforms or other CRM/claims systems
• Knowledge of annuity products, settlement options, and tax considerations
• Experience working in a regulated environment
• Familiarity with quality controls, audits, or compliance reviews
• Experience working with productivity metrics, quality standards, or performance scorecards
• Comfort using AI-enabled tools (e.g., Copilot) or automation to improve efficiency and effectiveness

Key Competencies for Success

• Accuracy and sound judgment
• Customer-focused mindset
• Clear documentation and communication
• Time management and prioritization
• Problem solving and root-cause identification
• Flexibility, adaptability, and resiliency
• Growth mindset and continuous improvement focus
• Technology enablement (including AI tools such as Copilot)
• Collaboration across operations, quality, and business partners

Work Environment & Schedule

• Remote position
• Fast-paced, deadline-driven operations environment with high volume transactional and exception-based work
• Core hours are 9:00 AM–5:00 PM ET
• Work schedule may vary based on business needs

Mandatory Overtime Requirement

• Mandatory overtime is required during peak volume periods, system conversions, and other business-driven surges
• Willingness and ability to work additional hours, including evenings and weekends, as needed to meet operational and regulatory commitments

Culture & Values

How we work is guided by four expectations that show up in day-to-day decisions and performance standards: Engage with Candor, Be Highly Accountable, Take Calibrated Risks, and Deliver for Our Customers.

#LI-Remote

#LI-IN

What we offer you:

Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $53,000.00 to $87,600.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills.

• Market competitive base salaries, with a yearly bonus potential at every level. 

• Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave. 

• 401(k) plan with company match (up to 4%). 

• Company-funded pension plan. 

• Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs. 

• Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.  

• Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.  

• Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service. 

Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week.