Senior Claims Specialist II

You can look forward to

A Preferred Candidate has been identified

Job Summary:

Independently completes the most complex of administrative services for assumed claims and supports management as a subject matter expert so that department operations and deliverables are completed and objectives are met.  Provides leadership on daily processing and project initiatives. Consults with and provides expertise to management on client and non-routine claims and issues.  Supports audits and projects as assigned so that Claims is compliant and deliverables are met. 

Essential Functions:

• (50%) Independently completes complex administrative tasks requiring exceptional critical thinking skills and technical expertise to meet department production goals, operations, and deliverables. Responsibilities include but are not limited to:  Reviewing non-compliant treaty and resisted/litigation matters making appropriate recommendations to management. Reviewing and approving non-routine claim aspects for subordinate team members. Approving large dollar claims up to authority limit. Mentoring and training team members on complex, non-routine client issues. Creating plans, testing, monitoring claim-related Sage System and CURT changes, reporting and data correction requests. Communicating status and concerns to the department head, managers, and/or key stakeholders to ensure appropriate actions are taken.
• (30%) Independently completes complex claims data analysis and various reports so that correct and timely reporting is provided to all levels in the organization and other key stakeholders.  Tracks and administers novations, recaptures, and other dynamic claim situations so that claims meet treaty agreement obligations. 
• (15%) Audit and Project Support:  Provides support to claims leadership for internal and external audits so that Claims team is compliant with audit requirements and deadlines. Participates in special projects, including cross-functional projects as a subject matter expert representing the Claims team, providing an understanding of the business processes.
• (5%) Supports claims management in the direction and administration of claims through the development and implementation of policies and procedures and making recommendations for processing efficiencies, best practices and solutions so that department objectives are met.  Informs management of matters requiring escalation, team needs, and trends for guidance so that appropriate actions can be taken.

You come equipped with

Competencies:

• Manages Complexity
• Decision Quality
• Optimizes Work Processes
• Customer Focus
• Communicates Effectively

Essential knowledge, skills and abilities:

• Minimum 10 years reinsurance, life insurance or other related field experience
• College degree or equivalent business experience
• Ability to work independently in a team environment and manage internal and external demands of position with only minimal supervision
• Ability to exercise sound discretion with regards to decision-making and resolving non-standard situations
• Ability to offer informal leadership through directions and actions
• Proven organizational and time management skills; ability to handle multiple priorities and tight deadlines
• Proven interpersonal skills for work internally across departments, as well as with clients
• Intermediate MS Office:  Word, Excel, Outlook and Internet skills
• Professional written and verbal communication and listening skills

Desired knowledge, skills and abilities:

• Exceptional customer service skills
• Strong accounting skills
• Strong organizational skills
• Business analysis and/or training experience
• Life Insurance claims experience preferred
• Professional designation: FLMI, ACS, or FLHC  

Travel:

• No travel required

Total Compensation (Inclusive of Base + Bonus):

• $70,400 - $95,200