Examiner, Group Claims- Employer Stop Loss
Company: RGA Reinsurance Company
Posted on: March 17, 2023
Position OverviewThe ESL Group Claims Examiner analyzes high dollar
claims and determines eligibility of Group Stop Loss 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.
- Analyzes and determines eligibility of stop loss claims;
interprets and verifies that the proper provisions and limits are
established on RGA Group Re's administration system. Works directly
with MGUs and brokers to resolve questions and issues that arise
from these claims.
- Identifies claim and underwriting issues that might affect the
claims process or administrative services. Interacts with the
underwriting department on contract and claim issue. May escalate
issue to Team Lead and/or Department Manager, where
- Participates in internal claim audits, marketing visits, client
training, and industry meetings.
- Accurately adjudicates and processes payment for approved
claims via ACH or wire transfer within authority limits.
Participate in user testing, where appropriate.
- May cross-train on other products such as Medical/Managed Care
RequirementsEducation and Experience Required
- Associate Degree or equivalent experience in insurance,
reinsurance or financial services.
- 2-4 years claims adjudication experience in Stop Loss claims.
- 5+ years claims adjudication experience in Stop Loss
- Progress toward ARA, FLMI, ALHC or other relevant professional
- Familiarity with processing claims in the ESL system. Skills
and Abilities Required:
- Basic Microsoft Word Skills
- Intermediate Microsoft Excel Skills
- Intermediate Microsoft Outlook Skills
- Ability to read and interpret insurance documents` and
reinsurance treaties and apply appropriately.
- Ability to be flexible when needed, take initiative, and
- Intermediate oral and written communication skills, and the
ability to share and impart knowledge
- Ability to quickly adapt to new methods, work under tight
deadlines and stressful conditions.
- Ability to set goals, multitask and prioritize workload.
- Basic level of investigative, analytical and problem-solving
- Ability to work well within a team environment and participate
in department projects
- Ability to balance detail with departmental
- Ability to foster customer service as needed
- Ability to liaise with individuals across a wide variety of
operational, functional, and technical disciplines and work well
with all levels of management.
- Ability to travel up to 5% required Preferred:
- Proficient knowledge of medical terminology and Coding Company
OverviewReinsurance Group of America, Incorporated (NYSE: RGA) is
one of the largest global providers of life reinsurance, with
offices around the world. RGA delivers expert solutions in
individual life reinsurance, individual living benefits
reinsurance, group reinsurance, financial solutions, facultative
underwriting, and product development. Our mission is to enhance
our clients' prosperity by supporting their financial and risk
management capabilities. State of Colorado: This information is
provided per the Colorado Equal Pay Act. The pay range for this
position in Colorado is $47,570- 64,185 per year. Base pay varies
depending on job-related knowledge, skills, experience and market
location. In addition, RGA compensation includes an annual bonus
plan that includes all roles and maintains a full range of
competitive health and life insurance, retirement and other
employee benefits. #LI-OJ1 #LI-Remote
Claims & Administration
Keywords: RGA Reinsurance Company, Chesterfield , Examiner, Group Claims- Employer Stop Loss, Other , Chesterfield, Missouri
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