Senior Claims Examiner

The Senior Claims Examiner analyzes high dollar and complex claims. Verifies that the underlying cession(s) is eligible for reinsurance. Reviews claims in litigation, claims on deaths outside the US and early death claims to identify undesirable trends in underwriting and/or claims adjudication practices that indicate a need for discussion with the client. Refers claims to Underwriting, Medical and/or Legal departments when required. Assists in developing and implementing improvement processes for Claims. Handles retroceded claims that require manual processes.

• Analyzes and processes high dollar, complex claims, claims in litigation and early death claims; verifies that the cession claimed was properly ceded to RGA Re and was properly established on RGA Re administration system. Takes steps to resolve questions that arise from these claims.
• Identifies undesirable underwriting and/or claim adjudication practices that require a need to elevate claim.  Refers claims to underwriting, medical and/or legal departments. May escalate issue to department vice president.
• Processes retroceded claims: assures that recoverables on large, complex retroceded claims are paid to RGA on a timely basis.
• Identifies opportunities for investigation or application of “best practices” in client claim activities.
• Participates in internal and client claims audits, as needed, including potential onsite audits.
• Verifies daily claim register by scanning the register to ensure accruals are reasonable, required fields are completed and that the register is free of obvious errors.  Authorizes accrual vouchers.
• Assists in training of new or junior associates.
• Processes payment for approved claims via ACH, wire transfer or check.

Education and Experience

Required:      

• Bachelor’s Degree or equivalent experience in insurance, reinsurance or financial services
• 6+ years life reinsurance or life insurance claims experience or 6 years combined experience in life claims and life underwriting

Preferred:     

• Reinsurance industry knowledge
• Progress toward FLMI, ALHC or other relevant professional accreditation

Skills and Abilities

Required:

• Basic Microsoft Word Skills Intermediate Microsoft Excel Skills Basic Microsoft Outlook Skills Basic SQL skills
• Basic Query skills
• Must be flexible and adaptive to change Takes initiative and is accountable
• Ability to read and interpret insurance and contract documents Ability to multi-task
• Basic goal setting skills
• Ability to share and impart knowledge Value judgment abilities
• Ability to balance detail with departmental goals/objectives
• Ability to work independently and coordinate activities within a team Advanced written and oral communication skills
• Intermediate investigative skills
• Complex analytical and problem solving skills
• Demonstrated ability to negotiate with internal and external customers to resolve issues/problems
• Strong customer service orientation Proficient knowledge of medical terminology

Compensation Range:

$63,400.00 - $90,050.00 Annual