VA Director of Claims - (US-VA-Virginia )

Minimum Education: Tech School
Job Type: Full Time
Jobcode: 775
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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.



About The Regent Group:
The Regent Group is a recognized leader in executive search and professional staffing for companies involved in the assessment, management and transfer of risk. Our consultants have extensive backgrounds both in executive search and in serving the needs of the insurance and risk management industries, as well as specific knowledge of the unique issues and trends facing our clients.

We have worked extensively with companies of all sizes, at all stages of the corporate life cycle from startups to runoffs and with all forms of ownership from privately held to mutual owned and publicly traded. Our ability to serve the complex needs of our clients derives from understanding their business from a senior management perspective as an insider, not an outsider.