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Posted December 17, 2018

Role title: Senior Claims Examiner – US Life
Department: Claims Services
Reporting Manager: Reinsurance Manager; interim AVP Member & Policyholder Services
Posting period: Nov 2, 2018

Purpose of role

As a Member of the Claims team you will be accountable for ensuring that all claims are adjudicated and administered according to state laws and in a fair, ethical and efficient manner. The Claims Examiner will also be responsible for answering claims related phone calls and managing the monthly Claims Reporting.

In addition this role requires the Claims Examiner be accountable for the reinsurance administration, which includes paying reinsurance premiums, recovering reinsured claims, ensuring the claims are in compliance with the treaty terms, are processed in a timely manner, as well as the ongoing monthly reporting and reconciliation required to insure adequate oversight of the reinsurance activity.

Key responsibilities/accountabilities:

  • Adjudicate various types of claims including Life, Annuity and Waiver of Premium. This includes identifying, collecting and reviewing all relevant information needed to determine the claim ligitimacy and eligibility as well as the benefit amount payable.
  • Request and review the requirements of the appropriate state legislation and regu lation s related to the type of claim being reviewed.
  • Perform all necessary benefit calculations and ensure all related activities are in compliance with state statutory and internal standards.
  • Determine outside resources needed to evaluate claim s and be ab le to communicate effectively with any outside resources such as medical consultants, legal consultants, independent physicians, coroners, police or investigative services.
  • Determine which claims need to be referred for evaluation and decision , based on a uthority limits, business case issues or referral to legal counsel.Maintain and update system records as necessary, and perform monthly reconciliation reporting
  • Responsible for reinsurance administrative functions for all reinsured policies , including billing, claims recovery and reinsurance reporting
  • Establish proactive and collaborative working relationships with key business areas including Actuarial, Finance, Underwriting and other key cross functional areas within Foresters.
  • Liaise on a regular b asis with reinsurance companies regarding billings, inquiries and reinsured claims processing and collection of claims.
  • Prepare monthly, quarterly and annually claims and reinsurance reporting

Key qualifications/competencies:

  • 5 – 7 years insurance experience adjudicating life and annuity claims , including contestable and waiver of premium
  • Four year college degree or equivalent experience
  • Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine as it relates to the claims adjudication.
  • Knowledge of the interpretation and application of state regulations as it relates to claims adjudication
  • Self - starter and ability to work with little supervision, with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast paced environment
  • Advan c ed verbal and written communication skills used to effect ively communi cate with internal and external customers, partners and vendors.
  • Strong reasoning and judgment to make informed claims and financial decisions, prioritize commitments, all while maintaining quality and customer care as a main focus
  • Understanding of genera l accounting principles
  • ALHC or LOMA designations desirable
  • Intermediate to advanced experience with Microsoft Excel and the ability to administer reports; Access experience a plus
  • Reinsurance e xperience desirable
  • This position may afford some opportunity of regularly scheduled work from home days during a work week

To apply:

To pursue this opportunity, please email your covering letter and current resume, quoting reference # xx to HR@Foresters.com by xx


Posted December 12, 2018

Claims Analyst
Salt Associates

Our Mission: Be Good People. Build Relationships. Solve Problems.

Do you want more than "just a job"? Are you looking for meaningful work that impacts lives? Are you a team player who embraces change and loves a challenge? If this all resonates and you are an experienced claim management professional, we have just the opportunity for you.

SALT Associates, an RGAX company, has immediate openings for seasoned claim analysts who can bring expertise in the following insurance lines: individual or group disability, life, life waiver of premium, or long term care.

Position Overview

The Claims Analyst position is a key, customer facing position within the Claims Operations department. This position may take on multiple responsibilities including managing claims within a customer environment, providing expertise and advice to customers, and supporting claim operation audits or consulting arrangements.

Responsibilities:

  • Facilitate appropriate outcomes with Claimant customers through proactive phone communication, expert product and contract knowledge, creative thinking, compassion, and integrity.
  • Build strong relationships with customers by listening, being creative, patience, and objectivity.
  • Maintain data integrity on Salt and Client systems by gathering and entering accurate claim data into claim systems, validating existing data, creating professional unbiased file documentation, utilizing correct grammar and spelling, ensuring documentation is clearly outlined, and minimizing use of abbreviations and acronyms
  • Learn new computer systems quickly and be comfortable working on multiple systems simultaneously
  • Comply with state laws, contracts and client procedures
  • Follow client-specific workflow while also offering feedback and recommendations for improvement and efficiency gain
  • Demonstrate willingness and aptitude to learn new types of insurance, e.g., Short Term Disability, Long Term Disability, Life Waiver, Individual Disability, Long Term Care
  • Achieve results as outlined in each specific project scope
  • Support other members of the Claim Operation when appropriate

Required Educational and Experience:

  • High School diploma

Preferred:

  • Bachelor's Degree preferred
  • Minimum of two years of experience in claim administration

Skills and Abilities:

  • Excellent customer service skills
  • Critical thinking skills
  • Demonstrated ability to effectively communicate via telephone and strong letter writing skills
  • Willingness to learn, lead, be led, support others, and work hard
  • Attention to detail, thorough and accurate
  • Complex problem solving
  • Occasional travel may be required for onsite audits or client relations.
  • Excellent work ethic
  • Flexibility
  • Ability to work independently as well as part of a team

If this is the right position for you, please submit a copy of your resume to our Talent Acquisition Partner at Ojackson@rgare.com for more information.