Director of Claims
Reference #: TRG0319775
Location: Virginia

Director of Claims
Virginia

SUMMARY
East Coast mutual insurance company which markets individual life and annuity products to various markets is seeking a Director of Claims.

RESPONSIBILITIES:
This position has the primary responsibility for management of all Individual and Group claims functions, including staff management, budgeting, planning and claims risk management. The ideal candidate will have Life & Health Insurance claims experience, be a strong leader and possess strong transactional process skills.

* Analyze, interpret and apply the terms and conditions of the reinsurance contract
* Perform post claim audits.
* Maintain detailed schedule of stop loss submission by claimant as well as summarized receivables.
* Coordinate and maintain recoveries on subrogation claims.
* Coordinate large case management on high dollar claimants.
* Monthly calculation and reporting of Aggregate claim data.
* Manage all incoming specific and aggregate reimbursement claim requests from Third Party Administrators.
* Audit reimbursement requests for compliance within stop loss contract limitations and guidelines.
* Review and document all potential large claims notifications from client TPAs for reporting and tracking purposes.
* Interact with outside bill review and medical review entities on pre and post payment audits and reviews to reduce the potential losses on high dollar complicated claims.

QUALIFICATIONS
A Bachelor's degree or equivalent education plus experience is required. Also a minimum of 5 years experience in dental, disability or life claims processing and at least 3 years in a management or supervisory role with budget accountability is preferred.

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