Posted 23 days ago

The Account Representative, Individual Life Claims will assess Individual Life and Accidental Death and Dismemberment claims expertly and efficiently, as well as evaluate client claim practices, perform reinsured client reviews and conduct industry presentations.

Claims Adjudication:
• Adjudicate complex, contestable claims, manage litigated cases, including processing compromised settlements, review high dollar, early duration claims to determine if the ceding company is following their guidelines, make recommendations to the Claims review Committee.
• Conduct expert individual life and AD&D insurance adjudication within internal standards and client response timelines;
• Monitor coverage assessment including promptly identifying, addressing and resolving coverage matters;
• Promptly issue payments in accordance with payment authorization protocols and client service level agreements;
• Manage and archive all claim documentation in an appropriate and orderly manner; proactively manage claim file follow up process;

Client Management:
• Establish strongly positive, mutually beneficial, long-term client relationships;
• Monitor client claim results and provide business partners with accurate client information on a timely basis through claim analytics, data mining and trend analysis;
• Assist with identifying/implementing initiatives to enhance claim handling efficiencies and effectiveness;
• Develop and implement strategies to track and improve deteriorating client claim results.
• Lead on external client audits including completing the audit report, identify training opportunities, conduct training and present at industry meetings and create claims tools for our clients.

Your profile

Qualifications
• Bachelor’s Degree and at least 8-10 years of life claims experience required
• Experience as an intermediate or senior individual claim assessor.
• Thorough working knowledge of Microsoft Office suite (advanced Microsoft Excel, Word and Outlook Experience).
• Strong communication skills, written and oral
• Excellent presentation creation and delivery skills
• Audit experience in some capacity required
• Ability to work independently and with a team
• Strong analytical and inquisitive skills; excellent attention to meeting time service and achieving deliverables.
• In-depth knowledge of direct insurance company claims operations
• Related experience in reinsurance, medical concepts or financial analysis will be an asset.

Mission
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Account Representative - Individual Claims