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Posted May 22, 2018
Provides specialized knowledge and expertise to assure that the practices and procedures of the claims process are up-to-date and in compliance with various state regulations and contractual obligations.
Essential Job Functions
- Reviews, examines and directs processing of unusual or difficult claim cases, resisted claims, compromise settlements, interpleaded actions or litigated claims. Assures the validity of claims and associated claim processes by providing consultative services to claims examiners for unusual or difficult claims, contestable, suicide exclusion, homicide or accidental death claims.
- Communicates with claimants, sales personnel, Legal and other departments to investigate claims, interpret information, resolve complaints or discuss matters relevant to effective claims administration.
- Consults with management and Legal on claims investigations, denials and rescissions as well as interpretation of contracts and regulations to direct and make decisions on claims processing, Represents Claims in Legal mediations and dispositions.
- Stays up-to-date on industry best practices, processes, trends and regulations. Conducts research, interprets information and makes recommendations to ensure WoodmenLife is in compliance. Translates regulations and other changes into new processes for claim examiners. Participates in the ACLI, ICA and other organizations as required.
- Leads and/or participates in internal and external audits, such as market conduct, death matching, unclaimed property, Ernst and Young, financial exams, SEC, etc.. Conducts regular quality audits of Claims work to ensure correct processes are being completed, analyze trends, and implements actions needed.
- Determines liability on claims promptly and accurately in accordance with WoodmenLife policy, applicable laws and contract provisions. Reviews and signs off on claims within the established department approval limits.
- Maintains optimal knowledge of claims procedures and systems. Analyzes procedures and systems and provides input to ensure efficient workflow and processes that are in compliance with current procedures, best practices and regulations.
- Adheres to Core Operation’s Behavioral Standards including focusing on solutions, being open to feedback and dialogue, taking initiative, and be involved and accountable.
- Meets expectations for attendance and punctuality in accordance with the expectations established by your supervisor and WoodmenLife policy.
- Performs other duties as assigned by management.
- Bachelor’s degree or equivalent education/experience, including aminimum of 7 years claims processing experience.
- Experience interpreting and applying knowledge of life and annuity insurance contracts, terminology and regulations to direct claims processes and decisions.
- In-depth knowledge and comprehension of industry claim best practices. In-depth knowledge of WoodmenLife claims policies and procedures or ability to learn these quickly.
- Demonstrated critical thinking skills with the ability to analyze and interpret data, apply knowledge and logic, problem solve and make sound decisions
- Excellent written and verbal communication skills including the ability to communicate thoughts clearly and concisely to influence and persuade others.
- Self-starter who can multi-task and work independently with minimal supervision.
- Ability to work with a high level of concentration and attention to detail as well as organize and prioritize work in order to effectively meet deadlines.
- Ability to maintain confidentiality, sensitivity and professionalism.
- Ability to engage well with others and be passionate about providing an exemplary customer experience
- Ability to provide seamless, trustworthy, attentive and resourceful (S.T.A.R.) customer service.
WoodmenLife offers a competitive compensation package and a comprehensive benefits package. As part of WoodmenLife’s employment process, candidates will be required to complete a criminal background check, credit check (where required for position), drug screen and reference checks. Any offer of employment will be contingent upon successfully passing the above.
WoodmenLife is committed to excellence in diversity by creating an inclusive work environment that values and respects all individuals. We welcome and embrace associates, regardless of background and beliefs.
WoodmenLife respects every associate’s unique perspective and contribution.
We are committed to creating an inclusive environment that values differences, and creates opportunities for growth, leadership and service.
This commitment includes providing equal opportunity in recruitment, employment and promotion, training and community outreach. WoodmenLife is also dedicated to strengthening the communities in which its employees live.
APPLICANTS WITH DISABILITIES SHOULD ADVISE THE HUMAN RESOURCES DEPARTMENT AT THE TIME OF APPLICATION IF SPECIAL ACCOMMODATIONS ARE NEEDED.
Woodmen of the World Life Insurance Society (WoodmenLife) is an equal opportunity employer.
Posted February 28, 2018
Reinsurance Group of America, Incorporated (NYSE: RGA) is a leader in the global life reinsurance industry with approximately $2.9 trillion of life reinsurance in force and assets of $44.7 billion. We are one of the largest life reinsurance companies in the world and currently hiring for an Associate Director of Claims for our Chesterfields, MO. Location.
The Associate Director Claims, leads and manages a team of associates performing single tasks or closely related multiple tasks that may be complex, including: processing of claims including early death claims, claims in litigation, deaths outside the US, liability reviews, claims management reporting and other related activities. Performs managerial duties, and develops and mentors associates. Recommends and participates in the development and implementation of process improvements that may extend beyond the area of oversight. Manages to avoid financial surprises in Claims.
- Performs supervisory duties for associates who perform routine to complex duties, including, but not limited to hiring, training, evaluating, coaching and disciplining direct reports. Fosters a positive and engaged work environment. Mentors associates and provides guidance on associate development.
- Assists in planning, setting of goals and ensuring the objectives of the department are met. Collaborates with other members of the US Ops Management team to implement and manage to goals/plans/budgets that align with division and company objectives.
- Assesses projects, develops plans, and assigns and assesses work of staff.
- Develops positive relationships with customers and discusses settlement of specific claims matters or a change in the client’s overall practice to align with RGA Re’s claims philosophy.
- Manages processes, reports and staff to avoid financial surprises from unexpected claims backlog/results.
- Works with all departments in the Operations division and other departments within RGA Re to identify and resolve problems/issues, including internal audit and SOX matters
- Recommends and participates in the development and implementation of process improvements that may extend beyond area of oversight and with the approval of Operations leadership.
Education and Experience
- Bachelor’s Degree or equivalent experience;
- 8+ years insurance related experience
- 5+ years experience in a supervisory or managerial position
- Reinsurance industry knowledge
Skills and Abilities
- Intermediate Microsoft Word Skills
- Intermediate Microsoft Excel Skills
- Basic Microsoft Outlook Skills
- Intermediate SQL Skills
- Competent ability to comprehend and interpret insurance and contract documents
- Ability to multi-task and meet tight deadlines
- Ability to share and impart knowledge
- Ability to balance detail with department goals and objectives
- Advanced written and oral communication skills and organizational skills
- Advanced ability to investigate, analyze and solve complex problems/issue
- Advanced persuasion skills when working with external customers to resolve issues/problems
- Ability to manage multiple teams or projects
- Advanced interpersonal skills, demonstrating the ability to manage, mentor and develop support staff
- Advanced ability to foster a teamwork and customer service focused environment
- Must be flexible and adaptive to change
- Basic goal setting skills
- Change initiation skills
- Ability to resolve conflict
- Ability to improve processes and add value.
- Advanced Query Skills
- Knowledge of medical terminology to support the Claims Department