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Senior Claims Examiner
2 months ago
We are seeking a highly skilled and experienced Senior Claims Examiner to join our team at RGA Reinsurance Company. As a Senior Claims Examiner, you will be responsible for managing all aspects of analyzing high-dollar claims and determining eligibility for complex Group Reinsurance claims.
Key Responsibilities- Claims Analysis and Eligibility: Analyze complex Group Reinsurance claims to determine eligibility and make recommendations for reserves or reserve assumptions.
- Technical Expertise: Provide technical expertise on complex claim and underwriting issues that may affect the claims process or administrative services.
- Leadership and Collaboration: Act as a lead resource for Senior-level Claim Examiners, Underwriters, Account Managers, Actuarial, Finance, Legal, and IT staff, and provide guidance and support as needed.
- Process Improvement: Identify and implement process improvements to enhance the claims process and administrative services.
- Communication and Collaboration: Communicate effectively with internal and external stakeholders, including Ceding Companies and/or Brokers, to resolve complex claims issues.
- Quality Control and Audits: Perform internal quality reviews and external claim audits to ensure compliance with Risk Management Guidelines.
- Adjudication and Payment: Accurately adjudicate and process payment for approved claims via ACH, wire transfer, or check.
- Workload Management and Mentorship: Appropriately distribute claim workloads within assigned business units and mentor junior associates on Group Claims.
- System Administration: Coordinate Group Re Claim administration system and Imaging system issues and enhancements, develop requirements, and act as a lead testing resource for IT.
- Education and Experience: Bachelor's Degree or equivalent experience, and 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.
- 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, and ability to work well within a team environment.
RGA Reinsurance Company is a leading provider of reinsurance solutions for the life and health insurance industry. We are committed to making financial protection accessible to all, and we are seeking talented individuals to join our team.
