Senior Reinsurance Claims Examiner

Role Description

Responsible for addressing all claim issues related to Assumed Accounts assigned by gathering information necessary to make informed and responsible decisions to bring claims to appropriate resolution.

Key Accountabilities

• Within established authority administers claims for assigned Assumed accounts. Conducts coverage verification, investigation, evaluation, reserving and authorization of claims payments and recovery.
• Manage claim activity and monitor all claim development for assigned accounts.
• Alert Management of significant loss development/activity.
• Evaluate and investigate claims to confirm coverage and identify any potential issues.
• Ensure proper reserving of reported claims through utilization of additional case reserves, proper documentation and disposition of individual excess of loss and pro rata accounts.
• Ensure timely processing of claim transactions.
• Ensure accuracy of processed claims payments. Coordinates with operations and accounting to confirm processing of prompt payments.
• Maintain accurate data of payments, reserves, scanned documents, new mail, etc.
• Maintain integrity of imaged claim files and maintain a diary system for assigned files.
• Analyze and produce reports highlighting large losses, coverage and critical issues for review by claims management and actuarial.
• Produce and analyze specific account data and generate reports in preparation for claim audits.
• Support reinsurance audits which will utilize the specialized skill developed during this person’s career to understand whether complex claims have been handled and ceded appropriately.
• Work with external customers to address questions, resolve problems and maintain rapport.
• In addition to the above key responsibilities, may be required to undertake other duties from time to time as the Company may reasonably require.

Qualifications

• Bachelor’s degree.
• 10+ years claims analysis experience with a Reinsurance/Insurance Carrier.
• General understanding of legal principles as they pertain to reinsurance claims.
• Requires experience across various lines of business, including GL, Property, Auto and WC.
• Requires the ability to understand the various reinsurance agreements which govern these lines of business, as well as the ability to comprehend complex loss presentations received by ceding companies.
• Ability to work independently.
• Ability to follow instructions, respond to management direction and solicit feedback to improve performance.
• Ability to demonstrate accuracy and thoroughness, monitor own work to ensure quality and apply feedback to improve performance.
• Ability to adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays or unexpected events.
• Ability to identify and resolve problems in a timely manner, gather and analyze information with good attention to detail.
• Detail oriented.
• Organizational skills.
• Ability to multi-task.
• Computer skills (Microsoft applications).
• Excellent written and verbal communication skills.

Benefits

• Enstar offers best-in-class bundled Medical, Dental, and Vision healthcare for single and family coverage.
• Board-certified doctors and pediatricians are available virtually 24/7 for urgent care.
• Access to Health Savings Account (HSA) or Flexible Spending Account (FSA).
• Access to Dependent Care FSA to cover daycare expenses.
• Access to Employee Assistance Programs (EAP) for health and well-being.
• Optional Pet & Home/Auto Insurance.
• Wellness Reimbursement program (up to $600 annual reimbursement for wellness-related expenses, i.e., gym memberships, massage, etc.).
• 401K retirement plan (company matches up to 6% of employee contribution).
• One paid annual volunteer day.