Manage all aspects in analyzing high dollar claims and determines eligibility of complex Group Reinsurance claims. Establishes monitors and updates system with appropriate reserves or reserve assumptions. Provide technical expertise with complex claim and underwriting issues that might affect the claims process or administrative services. Acts as a lead resource for Senior level Claim Examiners and lower, Underwriters, Account Managers, Actuarial, Finance, Legal, and IT staff. Acts as primary resource for claim unit procedural improvements and documentation.
Responsibilities
Serves as a technical expert for complex Group Reinsurance Disability, Medical/Managed Care and Life & Special Risk claims; interprets and verifies that the reinsurance claim was properly ceded to RGA Group Re and the proper provisions and limits are established on RGA Group Re’s Raptor administration system. Works directly with Ceding Company and/or Broker to resolve complex questions and issues that arise from these claims.
Identifies claim and underwriting issues that might affect the claims process or administrative services. Technical expert in interacting with underwriting department and account management on contract issues and Ceding Companies and/or Brokers claim appeals. May escalate issue to department manager and/or vice president of claims as appropriate.
Complete all risk control processes and reporting to ensure accurate and timely processing of assigned business. Directly responsible for preparation and distribution of some management reports.
Establishes, monitors and updates system with appropriate reserves or reserve assumptions.
Performs claim staffs internal quality reviews per Risk Management Guidelines, external claim audits, marketing visits, client training, operational reviews and industry meetings.
Accurately adjudicate and processes payment for approved claims via ACH, wire transfer or check. Also approves claim reinsurance reimbursements within authority limits.
Appropriately distribute claim workloads within assigned business unit and mentor junior associates (Senior Claim Analyst, Claim Analyst and Claim Tech) on any aspect of Group Claims.
Coordinates Group Re Claim administration system and Imaging system issues and enhancements, develop requirements, and act as a lead testing resource for IT for more complicated defects and enhancements.
Drive process improvements and documentation for claims and lead applicable procedural reviews and updates to within assigned business unit.
Requirements
Education And Experience
Required:
Bachelor's Degree or equivalent experience
8+ years of experience in Life, Disability and or Medical insurance or 8+ years of experience in Life, disability, and/or medical reinsurance claims; including mentoring and or supervisory experience
Preferred
Reinsurance industry knowledge
Medical/HMO model and or Provider experience
Skills And Abilities
Advanced Microsoft Word, Excel and Outlook Skills
Proficient Query or Business Objects skills
Advanced knowledge of group reinsurance products and business processes.
Ability to read and interpret insurance documents ‘and reinsurance treaties.
Ability to be flexible when needed, take initiative, and demonstrate accountability.
Advanced oral and written communication skills demonstrating ability to share and impart knowledge.
Ability to quickly adapt to new methods, work under tight deadlines and stressful conditions.
Ability to set goals, multitask and prioritize workload
Advanced level of investigative, analytical and problem solving skills.
Ability to work well within a team environment and participate in department/team projects.
Ability to balance detail with departmental goals/objectives.
Intermediate interpersonal skills.
Ability to translate business needs and problems into viable/accepted solutions
Ability to foster customer service as needed.
Ability to liaise with individuals across a wide variety of operational, functional, and technical disciplines and work well with all levels of management.
Ability to travel up to 10%
Advanced knowledge of medical terminology and/or medical coding
Our history, purpose, partnership, reinsurance, RGA Central (client portal), industry recognition, and risk assessment.
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The general pay range for this position is $74,150-$100,000 per year. Base pay varies depending on job-related knowledge, skills, experience, and market location. In addition, RGA provides an annual bonus plan that includes all roles, and some positions are eligible for participation in our long-term equity incentive plan. RGA maintains a full range of health, retirement, and other employee benefit.
Seniority level
Not Applicable
Employment type
Full-time
Job function
Finance and Sales
Industries
Insurance and Financial Services
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