Manager, Claims

Manages the department responsible for the processing and payment of all life, disability income, waiver of premium, accelerated benefit, fixed and variable annuity claims (SPG, TRG) in Cincinnati. Provides guidance on the most complex claims and has full managerial/staffing responsibilities for area.

1. Authorize life, disability income, waiver of premium, accelerated benefit, fixed and variable annuity claims for payment to proper individual and for proper amount. Authority limit is $750,000.
2. Approve or deny all contestable life claims. Coordinate with the Legal Department all litigation on policy-owner related lawsuits or denied claims, including completion of interrogatories, discovery requests, and other information requests. Participate in settlement discussions to resolve pending lawsuits. If necessary, testify at deposition or trial.
3. Manage department staff, including recruiting, hiring and training of new staff members; coach, develop, conduct and approve on-going performance review of department staff; assure consistent application of Company policies and procedures.
4. Develop, implement, and review procedures to insure that workflow within the department is completed according to company standards, state mandated regulations and SOX controls.
5. Coordinate all new-product testing within the department, and insure staff is fully trained on all new products introduced.
6. Resolve consumer complaints received directly or through the various state departments of insurance.
7. Assist staff in resolving difficult/complex claim situations.
8. Develop and monitor budget for two cost centers.

Associated Duties:
1. Coordinate requests for information from state insurance departments and external/internal auditors for market conduct examinations and various audits and studies. Review results and respond as needed.
2. Review monthly suspense reconciliation reports and claim balancing reports.
3. Update SOX controls as needed for both the life claim narrative and annuity claim narrative.
4. Prepare monthly status reports for supervisor.
5. Serve on various company related committees/projects such as the SIU committee or committee developing Anti-Money Laundry procedures.
6. Prepare monthly summaries for reinsurance companies on any reinsured pending litigation.

• Bachelor’s Degree, Business, Liberal Arts or related major
• FLHC or ALHC designation
• FLMI, ACS and AAPA designations preferred but not mandatory
• 10 years claim adjudication experience
• 5 years supervisory experience
• International Claims Association- attendance at annual meeting, review of fraud alerts, etc
• American Council of Life Insurance- review of bulletins and fraud alerts
• Association of Certified Fraud Examiners- review of bulletins and fraud alerts

Technical Knowledge:
IPD/Workflow and Claim System

If interested, please apply online at http://track.jobviper.com/ViewJob.asp?id=548778-3-453