Provides technical claims expertise to RGA Re claims associates and clients. Conducts internal claims audits to evaluate the quality of the claims reviews. Identifies process improvements and needs for training. Performs external client audits to verify accuracy of claims adjudication practices and to ensure compliance with the terms of the treaty(ies). Develops relationships with client companies and RGA Re associates to ensure desired changes in practice are obtained. Reviews and approves the liability on large, complex claims. Provides technical expertise on disputed claims. Represents RGA Re in various claims industry activities. May manage senior claims staff.
Develops and implements processes which allows RGA Re to identify and resolve unfavorable trends in ceding company claims handling.
Establishes and implements an internal and external process for effective customer claims evaluations and feedback.
Represents RGA Re at industry meetings (presenter, committee member) and exercises influence, as appropriate, with customers.
Develops positive relationships with customers and encourages their overall customer practice to the advantage of RGA Re.
Keeps up-to-date with changes in claims adjudication for direct insurance writers. Maintains an awareness of vendors to ensure quality and service. Acts as a resource to customers and other RGA Re associates to assure knowledge transfer.
Participates in the identification of service opportunities that will encourage enhanced client claim handling.
Acts in a consulting role with clients and RGA Re associates on large and complex claims.
Works with all departments in the Operations division and other departments within RGA Re to identify and resolve problems/issues.
Recommends and participates in the development and implementation of process improvements that may extend beyond area of oversight and with the approval of Operations leadership.
Collaborates with other members of the US Ops Management team to implement and manage to goals/plans/budgets that align with division and company objectives.
Maintains regular and predictable attendance.
Performs other duties as assigned.
Job Requirements :
Bachelor’s degree or equivalent related experience
8+ years individual life claims experience and 5+ years in supervisory or managerial role
Intermediate Microsoft Word Skills
Intermediate Microsoft Excel Skills
Basic Microsoft Outlook Skills
Intermediate SQL Skills
Experience in conducting and summarizing audits
Demonstrated expertise in the technical considerations associated with life claims investigations, adjudications and litigation.
Demonstrated understanding of the financial reporting implications of the life/health claims process.
Competent ability to comprehend and interpret insurance and contract documents.
Ability to multi-task and meet tight deadlines
Ability to share and impart knowledge
Advanced written and oral communication skills and organizational skills
Ability to balance detail with department goals/objectives
Advanced persuasion skills when working with external customers to resolve issues/problems.
Advanced ability to investigate, analyze and solve complex problems/issues.
Advanced interpersonal skills, demonstrating the ability to manage, mentor and develop support staff.
Ability to manage multiple teams or projects
Advanced ability to foster a teamwork and customer service focused environment.
Knowledge of medical terminology
Ability to travel 15 to 20% of the work schedule
Must be flexible and adaptive to change
Basic goal setting skills
Ch ange initiation skills
Ability to resolve conflict
Ability to improve processes and add value
Reinsurance industry knowledge
Progress toward FLMI, ALHC or other relevant professional accreditation
Advanced Query Skills
Reinsurance Group of America - 2 years ago