Claims Adjudication :
Conduct expert individual and group Short-Term and Long-Term Disability adjudication within internal standards, delegated authority limits and client response timelines;
Monitor coverage assessment including promptly identifying, addressing and resolving coverage matters;
Proactively investigate, assess, manage and resolve claim inconsistencies with clients;
Promptly approve payments in accordance with payment authorization protocols and client service level agreements;
Archive all claim documentation in an appropriate and orderly manner; proactively manage claim file follow up process.
Client Management :
Establish strongly positive, mutually beneficial, long-term client relationships through professional and knowledgeable communication;
Monitor client claim results and provide business partners with accurate client information on a timely basis through claim analytics, data mining and trend analysis;
Assist with identifying / implementing initiatives to enhance claim handling efficiencies and effectiveness;
Develop and implement strategies to track and improve deteriorating client claim results.
Risk Monitoring and Claim Reviews :
Identify and communicate exceptions to reinsurance treaty terms and claims where non-compliance exists to the internal business partners, and provide recommendations for resolution;
Perform client reviews according to reinsurance treaty contracts; produce excellent written analytical review reports with sound recommendations;
Conduct client review result presentations; follow up on recommended client actions to improve client review results;
Present claims to Senior Management for evaluation / authority including completion of pertinent claim summary reports and notice of high exposure claims.
Knowledge Transfer :
Create and deliver presentations and training programs for clients and internal business partners, via industry seminars or internal publications;
Provide technical mentoring on complex claims to other Claims team members;
Deliver leading-edge knowledge of group disability insurance claim investigations and practices to clients and internally.
Apply expert risk management knowledge to client claim situations and share expertise throughout the Munich Reinsurance Group e.
g. product development, contract wording;
Engage with pricing, underwriting, and legal to ensure treaty and contractual liabilities, product language and client decisions meet Munich Re’s risk standards and intent.
First and foremost, the successful candidate will be an accomplished Intermediate or Senior Case Manager who demonstrates a natural desire to provide exceptional disability case management through his / her knowledge, energy, enthusiasm and initiative.
In addition, we are looking for the following qualifications :
University degree in combination with CEBS, CSPDM, FLMI or other insurance designations.
Minimum 7 years Group insurance experience with thorough knowledge of Group disability claims. Exposure to different group types (union and non-union for example) and complex claims is an asset.
Bilingual (English / French) is a preferred asset.
Exhibits thoroughness, accuracy and attention to detail in claim reviews and data capture.
Strong analytical and inquisitive skills; excellent attention to meeting time service and achieving deliverables.
High degree of self-motivation, continuing development and proven ability to work independently.
Demonstrated desire and aptitude to learn other lines of business and claim types.
Excellent presentation and report creation and delivery skills. Strong oral and written communication skills..
Demonstrated ability to build solid client relationships.
Related experience in reinsurance and knowledge of underwriting / medical concepts and terminology will be an asset.