Position: RA2241 Title: AVP, Senior Claims Examiner, Accident and Health Salary: 120-150K + bonus Location: CT - Stamford (remote) Description:
Reinsurance Company is looking for a Senior Claims Examiner for the Accident & Health group. Depending on the candidate's experience, the position may be offered at the level of Assistant Secretary or Assistant Vice President. This job can be 100% remote. The role will need someone who can write and review claims and contracts this is more than a processing job. Stop Loss experience would be a plus and they will consider someone who has that experience in causality who is interested in switching to A&H. The job is looking for someone who will be a driving force in the success of the Accident & Health Claims team. You will be responsible for managing claims on varying product lines, collaborate with adjudication and cost containment vendors, ensure alignment with claims best practices and procedures.
Responsibilities:
Review, validate and process claims. Interpret reinsurance contract and policy language. Review vendor adjudication reports for accuracy, and issue reimbursements.
Analyzes and determines eligibility of Accident & Health claims; interpret and verify claims are correctly ceded and the proper provisions and limits are established on administrative and financial systems. Work directly with business partners to resolve questions and issues that arise from these claims.
Identify claim coverage issues and take initiative to resolve. Collaborate with management and underwriting team on claim issues and appeals.
Identify and conference coverage questions with management pursuant to best practices, including composing claims committees and large loss reports. Present facts of claims, with recommendations, to management as necessary.
Establish, monitor and update claims system with appropriate reserves.
Appropriately and clearly document all notes and file activity in a paperless claim system.
Accurately adjudicate and process payment for approved claims within authority level. Review and provide vendor adjudication reports to clients and Brokers via secure portals.
Engage with brokers, clients and 3rd party vendors, ensuring that the client’s needs are anticipated, addressed promptly, and handled with empathy and transparency.
Build positive working relationships internally & externally over remote communication tools.
Participate in marketing visits, in-house training, industry meetings and conferences.
Requirements:
Bachelor’s Degree or equivalent experience in insurance, reinsurance or financial services
10+ years experience with HMO Re, Provider Excess, Stop Loss and Managed Care claims handling/adjudication.
Proficiency with interpreting insurance documents/policies and reinsurance treaties
Intermediate/Advanced Microsoft Excel Skills.
Ability to work well independently as well as within a team environment.
Ability to maintain confidential information.
High standard of professional conduct.
Self-manage, take initiative, prioritize, and demonstrate accountability.
Advanced oral and written communication skills.
Strong investigative, analytical, and problem-solving proficiency.
Ability to identify issues and resolve them timely and appropriately.
Respond to broker/client requests in a timely and concise manner.
Broad understanding of the reinsurance/insurance industry and related organizational principles and practices.
Communicate in a clear and concise manner.
Comfortable with adapting to change and evolving methods.
Ability to liaise with individuals across a wide variety of operational, functional, and technical disciplines and work well with all levels of management.
Participate in marketing visits, client training, industry meetings and conferences.
