Senior Group Claims Examiner

You desire impactful work.
 

You’re RGA ready

RGA is a purpose-driven organization working to solve today’s challenges through innovation and collaboration. A Fortune 500 Company and listed among its World’s Most Admired Companies, we’re the only global reinsurance company to focus primarily on life- and health-related solutions. Join our multinational team of intelligent, motivated, and collaborative people, and help us make financial protection accessible to all.

A Brief Overview

The Senior Group Claims Examiner, analyzes high dollar claims and determines eligibility of Group Reinsurance claims. Establishes, monitors and updates system with appropriate reserves or reserve assumptions. Identifies claim and underwriting issues that might affect the claims process or administrative services.

What you will do

• Under supervision, analyzes and determines eligibility of Group Reinsurance Medical, Managed Care and or Stop loss 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 administration system. Works directly with Ceding Company and/or Broker to resolve questions and issues that arise from these claims.

• Identifies claim and underwriting issues that might affect the claims process or administrative services. Interact with underwriting department on contract issues and Ceding Companies and/or Brokers claim appeals. May escalate issue to Sr. Claim Examiner and/or Department Manager as appropriate.

• Establishes, monitors and updates system with appropriate reserves or reserve assumptions.

• Participates in internal claim audits, marketing visits, client training, and industry meetings.

• Accurately adjudicate and processes payment for approved claims via ACH or wire transfer. Also approves claim reinsurance reimbursements within authority limits. Participate in the administrative systems user testing.

• Potential cross training on all lines of Group Reinsurance business (Disability, Life & Special Risk and Medical/Managed Care).

Qualifications

• Associate’s Degree (AA) or equivalent experience in insurance, reinsurance, or financial services Required

• 2+ Years claims adjudication experience in Medical, Managed Care and/or Stop Loss insurance Required

• 5+ Years claims adjudication experience in Medical, Managed Care and/or Stop Loss insurance Preferred

• Basic Microsoft Word Skills Required

• Intermediate Microsoft Excel and Microsoft Outlook Skills Required

• Basic Query or Business Objects skills Required

• Ability to read and interpret insurance documents` and reinsurance treaties and apply appropriately. Required

• Ability to be flexible when needed, take initiative, and demonstrate accountability. Required

• Intermediate oral and written communication skills demonstrating ability to share and impart knowledge Required

• Ability to quickly adapt to new methods, work under tight deadlines and stressful conditions. Required

• Ability to set goals, multitask and prioritize workload. Required

• Basic level of investigative, analytical and problem-solving skills Required

• Ability to work well within a team environment and participate in department projects Required

• Reinsurance industry knowledge Preferred

• Proficient knowledge of medical terminology and Coding Preferred

• Progress toward ARA, FLMI, ALHC or other relevant professional accreditation Preferred

What you can expect from RGA:

• Gain valuable knowledge from and experience with diverse, caring colleagues around the world.

• Enjoy a respectful, welcoming environment that fosters individuality and encourages pioneering thought.

• Join the bright and creative minds of RGA, and experience vast, endless career potential.

Compensation Range:

$65,050.00 - $92,400.00 Annual

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 also maintains a full range of health, retirement, and other employee benefits.

RGA is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, age, gender identity or expression, sex, disability, veteran status, religion, national origin, or any other characteristic protected by applicable equal employment opportunity laws.