Claims Manager, NavRe A&H

5 days left

Location
Farmington, Connecticut
Salary
Not Specified
Posted
Oct 15, 2016
Closes
Dec 14, 2016
Ref
1-406019
Category
Claims
Job Type
Not Specified
Career Level
Not Specified

Responsibilities:

  • Adjusts and manages to conclusion all A&H excess of loss (XOL) claims. Handles claims with significant dollar exposure and extensive complexity as to claim details and coverage.
  • Establish reserving process for XOL claims and implement within Navigators internal systems. On an ongoing basis, establish case reserves for financial reporting purposes to ensure that claims are promptly evaluated and appropriately reported internally.
  • Support underwriters during underwriting/pricing process by review of ongoing claims. Determine estimated claim amount for current year and projected claims for upcoming year to support underwriters rate or coverage actions.
  • Plan and perform claim audits of clients as needed. Prepare audit report and help clients implement any suggested improvements/changes.
  • Develop approved external vendor list to support clients and Navigators efforts to control claim costs.
  • Primary client resource for all claim questions and issues. Works closely with clients to ensure proper claim procedures are followed. Supports President, A&H Underwriting for any claims with potential legal or regulatory issues.
  • Ability to assess quality of PPO networks and negotiated discounts to support Underwriters in determining managed care discounts.

Requirements:

  • Excellent oral and written communication skills.
  • Extensive knowledge of medical claims.
  • Excellent knowledge of claim reporting functions and processes.
  • Strong negotiation skills and people skills.
  • Customer service oriented.
  • Intermediate knowledge of Excel with strong computer skills.
  • Bachelor's or equivalent degree required.
  • 10+ years of actual medical claim experience.
  • Some travel is required.
  • Experience at a reinsurer, MGU or stop loss carrier is desirable.

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