Lead Claims Specialist - Reinsurance

The Opportunity: This role will support the Claims Manager in managing assumed reinsurance excess of loss and proportional business for QBE Reinsurance's A&H portfolio, ensuring proper reporting and documentation of all claims following reinsurance contract terms. The Lead Claims Specialist will perform complex claims review by conducting claims data analyses, health and billing records assessments and validation of eligible benefits and losses under the plan contracts. The role will assure timely and accurate reserves are approved and recorded. Adjudicate claim payments within approved authority level and refer complex claims for clinical review when appropriate. Provide effective communications, data support, and collaboration with Global Claim department, Underwriting, Actuary, Legal and other internal teams. Participate in program management and provide claims support to external clients, brokers, vendors and auditors.

• Location: Minnesota - remote
• The starting salary for this role is between $101,000.00 and $151,000.00

Your New Role:

• Implement the administration of reinsurance coverage to complex claims by conducting loss
  investigations, analyzing claims data and records, interpreting underlying policy benefits, and applying legal and technical knowledge to independently resolve claims files in a timely manner
• Foster and facilitate effective communications with brokers and clients to obtain records and data for claims management and adjudication with a collaborative customer service approach
• Provide expert claim support and project management in collaboration with Underwriting and Actuary
• Participate in team and program meetings with internal and external clients
• Perform accurate claims review, reconciliation of claims payments and refunds, and adjudication of eligible losses
• Support the implementation and communication of the Claims strategy to enable the delivery of overall business goals
• Contribute to the development of strategies, processes, and procedures for the Claims operation to support the delivery of business targets and department goals
• Assist in the forecast of Claims activity through analysis of claims data and complete large reserve reporting within approved authority levels
• Triage complex cases for clinical and cost containment review and facilitate referrals for external vendor claim audit or negotiations as delegated by Claims Manager
• Implement processes and procedures to ensure compliance with both statutory and corporate service standards and statutory regulations.
• Maintain efficient handling of own caseload to ensure the prompt, timely, and effective handling of Claims including management of claims inbox and electronic tasks assigned
• Resolve customer service issues to ensure their prompt and timely resolution and escalate urgent needs to Managers as appropriate
• Develop and maintain good client relationships internal and external partners consistent with the QBE DNA
• Participate in continuing education and maintain compliance with required organizational learning

Work Experience:

Necessary Work Experience includes:

• Moderate relevant experience.

Preferred Work Experience includes:

• 5+ years direct experience in adjudicating and managing reinsurance A&H claims or medical stoploss claims per contract provisions.
• Experience with data analyses in support of cost projections and risk management with Underwriting and Actuary teams.
• Experience with plan document and health benefits verification for eligible coverage
• Experience with cost containment strategies and identifying outlier claims data for further investigation
• Experience working directly with clients and brokers for records requests and claims management
• Experience analyzing claims data and trends, summarizing data findings, and presenting the information in a clear and concise manner to internal and external clients

Qualifications:

Necessary Qualifications include:

• Tertiary Degree or equivalent combination of education and work experience.
• Proficiency with Microsoft Suite applications, specifically Excel, Outlook and Teams
• Working knowledge of TPA networks, medical billing records and codes, health care and medical terminologies, PBM and pharmacy data, general health benefits and coordination of benefits by program such as commercial vs government plans
• Excellent written and verbal communications for effective collaborations

Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance.We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.

QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to:

• Hybrid Working - a mix of working from home and in the office
• 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis
• Competitive 401(k) program with company match up to 8%
• Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice
• Tuition Reimbursement for professional certifications, and continuing education
• Employee Network and Community - QBE actively supports six Employee Networks, and many ways to give back to your community

To learn more, click here: Benefits | QBE US.

Why QBE? What if you could have a positive impact - at work and in the world?

At QBE, we're enabling a more resilient future - for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success.

Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact.

Join us now, so you can be part of our success - and we can be part of yours!

https://www.linkedin.com/company/qbe-north-america/

Commitment to Diversity

QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information.

Equal Employment Opportunity:

QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status.

Supplementary information

Skills:

How to Apply:

To submit your application, click "Apply" and follow the step by step process.

Equal Employment Opportunity:

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.