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Company Contact Info

  • 2 Court Street
    Binghamton, NY 13901

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Insurance Claims Director

Renaissance Life & Health Insurance of America • Binghamton, NY

Posted 1 month ago

Job Snapshot

Full-Time
Experience - At least 7 year(s)
Degree - 4 Year Degree
Insurance, Other Great Industries
Insurance, Management, Customer Service

Job Competition

3

Applicants

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Job Description

Renaissance Life & Health Insurance is seeking a Director of Claims!


What will this role entail?

  • Directs and evaluates departmental activities to ensure continuous improvement of programs and services for claims processing and provider network management.
  • Defines business requirements relevant to claims and participates in the review of system design, user acceptance testing, and implementation procedures, as well as evaluates and communicates the impact changes may have on the organization.
  • Develops, executes, and oversees project assignments, defines procedures and processes and assists in defining solutions to ensure claims are processed accurately and new products are implemented accordingly. Through this process, identifies areas for improvements.
  • Recommends and directs the research, development, testing, and evaluation of new initiatives, services, and programs for the administration of claims processing.
  • Oversees the management of authoring automated and manual business rules and policy to ensure claims processing is in accordance with client contracts and administrative processing policies. Ensures the completion of test cases and test scenarios for testing system functionality and rules.
  • Plans, develops, recommends, and oversees the implementation of short and long-term strategies, goals and objectives, new programs and service initiatives.
  • Interviews, hires, evaluates and develops staff in order to ensure accountability for achievement of department goals and objectives.
  • Ensures that departmental procedure manuals and claims processing reference materials are current and complete.
  • Manage daily operations of a department (or team). Prioritize workload and department (and team) goals, coordinate schedules and coverage needs, manage performance and employee relations issues.
  • Act as primary claims contact for reinsurers and third party claims administrators.
  • Evaluate, process, and audit high level and/or complex claims for assigned product types. Review and apply contractual terms and regulatory guidelines to claims.

Job Requirements

What must this candidate possess?

  • Bachelor’s degree in relevant area
  • A minimum of 7 years related experience in life and disability insurance
  • At least 5 years of direct experience managing staff. Will accept any suitable combination of education, training, or experience.
  • Position requires advanced knowledge of life and disability insurance products, including mandated disability and state and federal family leave programs in particular.
  • Strong verbal and written communication skills, ability to analyze and resolve complex problems and use independent judgment.
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