Lead Group Claims Examiner
2 weeks ago
We are seeking a highly skilled and experienced Lead Group Claims Examiner to join our team at RGA Reinsurance Company. As a key member of our claims team, you will be responsible for managing all aspects of analyzing high-dollar claims and determining eligibility for complex Group Reinsurance claims.
Key Responsibilities- Serve as a technical expert for complex Group Reinsurance Disability, Medical/Managed Care, and Life & Special Risk claims, interpreting and verifying 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.
- Identify claim and underwriting issues that might affect the claims process or administrative services, and work directly with Ceding Company and/or Broker to resolve complex questions and issues that arise from these claims.
- Complete all risk control processes and reporting to ensure accurate and timely processing of assigned business, and directly responsible for preparation and distribution of some management reports.
- Establish, monitor, and update system with appropriate reserves or reserve assumptions.
- Perform claim staff's internal quality reviews per Risk Management Guidelines, external claim audits, marketing visits, client training, operational reviews, and industry meetings.
- Accurately adjudicate and process payment for approved claims via ACH, wire transfer, or check, and also approve claim reinsurance reimbursements within authority limits.
- Appropriately distribute claim workloads within assigned business unit and mentor junior associates on any aspect of Group Claims.
- Coordinate 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.
- 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.
- Reinsurance industry knowledge.
- Medical/HMO model and/or Provider experience.
- 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.
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 our team is dedicated to delivering exceptional service and expertise to our clients.
We offer a competitive salary range of $74,150-$100,000 per year, plus an annual bonus plan and long-term equity incentive plan. Our comprehensive benefits package includes health, retirement, and other employee benefits.
If you are a motivated and experienced professional looking for a challenging and rewarding career opportunity, we encourage you to apply for this exciting role.
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