Claims Director Insurance Job

Orange County, CA

 

Insurance Job Description

Our client specializes in employer-sponsored group insurance and employee benefits while providing solid service and quality products throughout the United States. They presently offer an opportunity to join their claims team in a leadership role.

Claims Director Responsibilities:

  • Analyze, interpret and apply the terms and conditions of the reinsurance contract

  • Perform post claim audits.

  • Maintain detailed schedule of stop loss submission by claimant as well as summarized receivables.

  • Coordinate and maintain recoveries on subrogation claims.

  • Coordinate large case management on high dollar claimants.

  • Monthly calculation and reporting of Aggregate claim data.

  • Manage all incoming specific and aggregate reimbursement claim requests from Third Party Administrators.

  • Audit reimbursement requests for compliance within stop loss contract limitations and guidelines.

  • Review and document all potential large claims notifications from client TPAs for reporting and tracking purposes.

  • Interact with outside bill review and medical review entities on pre and post payment audits and reviews to reduce the potential losses on high dollar complicated claims.

Claims Director Qualifications:

  • Five or more years fully insured medical claims handling experience with one or more years of leadership

  • Established vendor relationships

  • Experience working with Third Party Administrators

Please contact Scot Dickerson for immediate confidential consideration and additional details. If you would like to submit your resume for this insurance job, please click HERE and attach your resume as a Microsoft Word document.

Capstone Insurance Search Group is a search firm dedicated to the insurance industry. We work nationally with expertise that spans top executives, middle management and technical level positions. We can provide assistance with a variety of product lines to include Property and Casualty, Life, Health, Disability, Annuity and Pension. We will provide you with a service that is of the highest degree of confidentiality, professionalism and integrity.