Technical Claims Consultant

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.

Overview

Performs external client quality assurance reviews (audits) to verify accuracy of Long-Term Care claims adjudication practices and to ensure compliance with the terms of the treaty(ies). Maintains relationships with client companies and RGA Re associates to ensure desired changes in practice are obtained. Provides technical expertise on complex - claims.

What you will do

• Performs external client quality assurance reviews (audits) to verify accuracy of Individual Health claims adjudication practices and to ensure compliance with the terms of the treaty(ies).

• Follows the internal and external process for effective customer claims evaluations and feedback.

• Performs data analysis of trends in risks and assessment of risks.

• Represents RGA Re at industry meetings.

• Maintains positive relationships with customers encourages their overall customer practice to the advantage of RGA Re. Discusses specific claims matters with clients.

• Keeps up to date with changes in long term care 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 LTC 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.

Qualifications

• Bachelor’s Degree in Arts/Sciences (BA/BS) or equivalent related experience required

• 6+ Years LTC claims adjudication experience required

• Individual Disability Insurance, Medicare Supplement and other Individual Health claims adjudication experience. preferred

• Advanced skills in conducting and summarizing quality assurance reviews (audits) required

• Advanced in the technical considerations associated with long term care claims investigations, adjudication and litigation. required

• Understanding of the financial reporting implications of the health/long term care claims process. required

• Ability to comprehend and interpret insurance and contract documents. required

• Ability to multi-task and meet tight deadlines required

• Ability to share and impart knowledge required

• Intermediate Microsoft Office and Excel Database skills required

• Advanced oral and written communication skills and organizational skills required

• Ability to negotiate when working with external customers to resolve issues/problems. required

• Ability to investigate, analyze and solve complex problems/issues. required

• Knowledge of medical terminology required

• Familiarity with the Reinsurance industry 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:

$74,150.00 - $105,295.00 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.