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SalaryClaims Risk Analyst
Continental General - Austin, Texas
Looking to join a growing company dedicated to helping others? We offer that, plus competitive salaries, great culture, and a relaxed environment.This position allows for a hybrid work environment.Join our team to help make a difference in the lives of others!
About Continental General
Headquartered in Austin, Texas, Continental General was incorporated as a life, accident & health insurance company in 1961. Our family of companies and strategic partners provide administrative services to over 100,000 policyholders. We are committed to the continuous development of our infrastructure, processes, and our people. With each opportunity, we take a collaborative approach to address challenges and provide unique solutions.
We are currently seeking aClaims Risk Analystwho will be responsible for reviewing long term care claim referrals and presenting findings to the claims FWA team for review. The Claims Risk Analyst will play a crucial role in identifying and managing risks associated with long term care insurance claims and contributing to developing strategies to mitigate them. By analyzing data, developing strategies, and collaborating with various stakeholders, they contribute to the effective and efficient management of claims processes while minimizing potential risks and losses for the organization.
Responsibilities:
Review claims data to identify patterns, trends, and potential risks.
Assess the potential risks associated with long term care insurance claims, such as possible fraudulent activity or policy violations.
Design and implement strategies to mitigate identified risks. This may involve creating policies, procedures, or systems to prevent or detect fraudulent claims, conducting claim reviews, or collaborating with other departments to improve claims management processes.
Monitor claims activities to identify emerging risks or trends. Generate reports and present findings to management, highlighting areas of concern and recommending actions to address them.
Document activity on each case and prepare summary and/or detailed reports on findings.
Draft all correspondence on enhanced due diligence cases and provide guidance on active cases.
Collaborate with other departments, such as SIU, legal, or compliance, to ensure alignment in risk management efforts. Providing guidance and support to claims examiners or other claims personnel on risk-related matters.
Ensure compliance with regulatory requirements and industry best practices related to claims management and risk mitigation.
Performs other duties as assigned.
Requirements:
Strong research skills and ability to interpret complex data
Knowledge of long term care insurance policies, claims processes, and risk management principles
Attention to detail and ability to spot patterns or anomalies in data
Excellent communication both verbal and written, and presentation skills
Problem-solving and critical-thinking abilities
Knowledge of relevant regulations and compliance requirements
Ability to work independently and as part of a team
Strong organizational and time management skills
Bachelor’s degree in Business, Criminal Justice, Healthcare, related field or equivalent experience.
Advanced Excel knowledge a plus
Prior long-term care insurance experience a plus
2+ years of claim investigation, claim audit, or fraud investigation experience a plus.
