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Examiner, Group Claims- Employer Stop Loss

Company: RGA Reinsurance Company
Location: Chesterfield
Posted on: March 17, 2023

Job Description:

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. Responsibilities

  • 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 appropriate.
  • 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. Preferred:
      • 5+ years claims adjudication experience in Stop Loss insurance
      • Progress toward ARA, FLMI, ALHC or other relevant professional accreditation
      • 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 demonstrate accountability.
        • 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 skills
        • Ability to work well within a team environment and participate in department projects
        • Ability to balance detail with departmental goals/objectives
        • 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

            Job Detail

            • Reference number

            • Date posted

            • Closing date

            • Location

            • Job Functions
              Claims & Administration

            • Work Location

Keywords: RGA Reinsurance Company, Chesterfield , Examiner, Group Claims- Employer Stop Loss, Other , Chesterfield, Missouri

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