Job Description : Summary
Investigates and adjusts highly complex third party bodily injury, disability income and property damage claims, processes subrogation claims, writes reports and performs other related tasks.
Determines and maintains equity with current claims trends and legislated requirements and programs. Recommends improvement to processes and implements same as appropriate.
Essential Job Functions
Analyzes highly complex insurance and matured endowment claims to ensure compliance with organizational and government guidelines.
Ensures the completeness and accuracy of the claims and identifies coordination of benefits with other insurers.
Presents findings of investigation of claims systems to highlight impact to organization. Evaluates and suggests adjustments or changes to systems as appropriate.
Reviews the analysis over claims financial reporting practices and reconciliation for client companies. Resolves complex claims processing errors and issues.
Reviews processes related to claim transactions and payments. Advises management about potential liabilities or process improvements related to current claims practices.
Coordinates between stakeholders including the company, attorneys, insurance brokers, carriers and offices.
Provides leadership and work guidance to less experienced personnel.
Bachelor's degree or equivalent combination of education and experience
Bachelor's degree in insurance, business administration or related field preferred
Six or more years of claims experience
Experience working with standard industry claims processing systems and tools
Experience with investigating internal claims practices
Experience working with appropriate claims processing procedures and documentation, and administrative procedures, legislative requirements, and medical principles as they relate to examination and approval of life and disability insurance claims
Strong analytical and problem solving skills
Strong interpersonal skills to interact with team members
Strong communication skills to communicate with clients
Good human relations skills to provide leadership and work guidance to less experienced personnel
Ability to keep sensitive and confidential material private
Ability to work in a team environment