Consultant - Claims

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General Summary

• Under limited supervision, analyses high dollar, early death, foreign and complex claims. Seeks to identify undesirable trends in claims and/or underwriting adjudication practices that indicate a need for discussion with the client. Seeks input from Underwriting, Medical and/or Legal departments when required. Assists in developing and implementing improvement processes for Claims. Handles retroceded claims that require manual assessment processes.
• Verity that the claims arising are within the relevant policy and treaty limits; resolving issues or referring to another relevant department, as required.
• Involved with the audit of clients, verifying accuracy of claims adjudication practices and to ensure compliance with the terms of the treaty(ies).
• Some travel requiring absences from home for approximate periods up to 30 days annually.
• This is the consultancy contract for the duration of 6 months to 1 year only
  

Key Responsibility

Strategic / Operations

• Under supervision, employee refers to a work program and deadlines. Decision making involves procedural actions on occasions where new circumstances arise but must stay within guidelines provided. Takes action in uncertain cases, referring problems to supervisor when required.
• Analyses and processes high dollar, complex claims and early death claims.
• Seeks to identify undesirable trends in claims and/or underwriting and takes steps to resolve questions that arise from these claims.
  

Financial Results

• Operational impact of actions on financial decisions or end results affects the performance of others in the company or moderately affects activities in the business unit, suppliers or customers.
• Works within the authorizations delegated in specific limits; approves and authorizes cash disbursements up to prescribed limits.
  

Business Development / Client Relations

• Identifies opportunities for investigation or application of “best practices” in client claim activities.
• Builds and maintains client relationships through effective communication of claims decisions, compromises and solutions in a professional, client-focused manner
  

Public Relations (Industry Involvement)

• Keeps abreast of current industry developments and changes in medical and financial claims management and maintains/updates professional development through study of literature and participation in seminars.
• Participates in special projects, committees, and meetings.
  

Infrastructure Overall

Standards / Procedures and Tools

• Identifies undesirable underwriting and/or claim adjudication practices that require a need to escalate issue to departmental Head/ Managing Director so as to take appropriate measure to mitigate risk.
• Retroceded claims assures that recoverable on large, complex retroceded claims are paid on a timely basis.
• Verifies daily claim register by scanning the register to ensure accruals are reasonable, required fields are completed and that the register is free of obvious errors. Authorizes accrual vouchers.
  

Company Structure

• Collaborates with CMO, Underwriters, Administrators, Valuation, business development and other team members to obtain expert knowledge and to assist in identifying solutions and resolutions to problems/issues resulting in quality decisions and client satisfaction.
  

Governance / Compliance

• Implement administrative procedures and controls for the individual claims management functions.
  

Risk Management

• Follows all individual claims and underwriting management procedures, authorities; follows established reporting and monitoring systems which are operational and as agreed within the risk management function of the company.
  

Requirements

• Bachelor’s Degree or equivalent experience in insurance, reinsurance or financial services
• Up to 2 years life reinsurance claims or life insurance claims experience
  

Skills And Abilities

• Communication Skills Identifies the information needs of stakeholders, explains the position of the unit or the organization to them and provides appropriate advice.
• Complexity of Reasoning Development of a new result by combining known information and techniques. Activities requiring the contribution of various resources (persons, spaces, material, budget etc.).
• Understanding of the general meaning of a set of data defined with relation to a specific result.
  

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.