Reinsurance Claims Auditor

Job Description Summary

Job Description

Roles and Responsibilities

• Conduct pre-audit review, communication, and sample selection activities in accordance with the audit scope and plan
• Perform desk and/or field claim audits, documenting findings and recommendations using our audit application
• Review audit findings, develop actionable recommendations and compose detailed audit reports
• Present audit results and coordinate response reconciliation activities with clients until audit closure
• Track follow-up actions from audits and monitor the implementation of recommendations to ensure resolution
• Provide ongoing support and input to clients regarding claim accuracy and fraud mitigation practices, as appropriate
• Review and adjudicate reinsurance claims, responding to internal and client inquiries promptly and accurately
• Analyze audit results metrics to identify processing trends and improvement opportunities
• Collaborate with the broader operations team and other organizational functions as needed

• The base pay range for this position is $71,000.00 - 95,000.00 - 119,000.00 USD Annual The specific pay offered may be influenced by a variety of factors, including the candidate’s experience, education, and skill set. This position is also eligible for an annual discretionary bonus based on a percentage of your base salary on the plan. This posting is expected to close on November 30, 2024

  Healthcare benefits include medical, dental, vision, and prescription drug coverage; access to a Health Coach, a 24/7 nurse-based resource; and access to the Employee Assistance Program, providing 24/7 confidential assessment, counseling and referral services. Retirement benefits include the GE Retirement Savings Plan, a tax-advantaged 401(k) savings opportunity with company matching contributions and company retirement contributions, as well as access to Fidelity resources and planning consultants. Other benefits include tuition assistance, adoption assistance, paid parental leave, disability insurance, life insurance, and paid time-off for vacation or illness. 

  General Electric Company, Ropcor, Inc., their successors, and in some cases their affiliates, each sponsor certain employee benefit plans or programs (i.e., is a “Sponsor”). Each Sponsor reserves the right to terminate, amend, suspend, replace, or modify its benefit plans and programs at any time and for any reason, in its sole discretion. No individual has a vested right to any benefit under a Sponsor’s welfare benefit plan or program. This document does not create a contract of employment with any individual.

Required Qualifications

• High School Diploma or equivalent.
• Minimum seven years (5) of experience in adjudicating insurance and/or reinsurance claims
• Proficiency in interpreting and applying insurance policy provisions, benefit eligibility requirements, and limitations.
• Working knowledge of medical terminology and medical impairments related to long term care, disability, life and/or health insurance claims.
• Excellent written and oral communication skills

Desired Characteristics

• Bachelor’s degree in business, management or insurance
• Experience in reinsurance claims
• Strong preference for long term care claim experience
• Ability to analyze, interpret, and present complex problems and solutions to diverse audiences
• A growth mindset with a focus on continuous improvement
• Strong organizational and prioritization skills 
• Proficiency in analyzing data to identify opportunities, evaluate options, and make informed decisions
• Knowledge of Microsoft Office Suite and ability to navigate other business-related software, including claim processing systems and applications.

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Additional Information