Senior Professional Claims Analyst (51006879)

Job Description:
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.

Basic Qualifications

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

Other Qualifications

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

Work Environment

Office environment