Job Description

Position Overview

Leads and manages the health services consultant staff within the ROSE Program including program development for services to ensure the programs maintain their leading edge status and support the business objectives of RGA. Oversees the healthcare claim reserving processes and ensures compliance with applicable federal regulations. Assists with the budget for ROSE/ROSEBUD department.

Responsibilities

* Leads and manages operations and performance of ROSE program and staff, including hiring, training, performance management and client assignments. Fosters a positive and engaged work environment. Mentors associates and gives guidance on associate development
* Establishes and oversees appropriate reserve practices and performs monthly reviews of reserve adequacy and oversees the communication of claims.
* Assists with development and management of ROSE/ROSEBUD budget.
* Assist with marketing ROSE program and supports sales staff.
* Maintains a modified client case load.
* Manages and fosters relationships with external vendors. Assists with negotiating service agreements with program vendors, in compliance with state and federal requirements and in coordination with RGA legal department.
* Performs quarterly claim reserve quality reviews required by SOX.
* Manages semi-annual outstanding claim reserve review process.
* Assists with developing and implementing new ROSE program products and services.
* Provides guidance on complex, high cost case consultation and claims management strategies.
* Assists in underwriting process with regard to evaluation of claims experience, future risk, and clients case and claims management capabilities.
* Liaison for team process/relationships with marketing underwriters and claims department.
* Audit/review clients case management and claims management practices on a regular basis. Direct Operational Review service (in-depth audit and formal report) of clients internal case management programs.
* Takes a lead role in planning and hosting of the Annual ROSE Conference and bi-monthly teleconferences, including identifying topics and speakers, obtaining CEU credits and determining events. Assists with soliciting sponsorship for the Conference.

Requirements

Education and Experience

Required

* Bachelors Degree in Nursing/related field with 8 to 10 years experience in managed care or healthcare environment including case management.
* 2-5 years management experience.

Preferred:

* Masters Degree or Certified Case Manager
* 5+ years reinsurance experience

Skills and Abilities

* Knowledge of accounting/finance
* Expert ability to analyze and improve business processes
* Highly advanced people management skills, demonstrating the ability to lead, mentor, and develop associates; including the ability to delegate key areas of responsibility
* Ability to quickly adapt to new methods, work under tight deadlines and stressful conditions
* Advanced oral and written communication skills, demonstrating the ability to convey business terminology that is meaningful and well received
* Advanced investigative, analytical and problem solving skills
* Ability to work well within a team environment, participate in department/team projects and balance detail with departmental objectives
* Advanced ability to manage multiple projects and/or teams simultaneously
* Advanced ability to liaise with individuals across a wide variety of operational, functional and technical disciplines
* Advanced ability to translate business needs and problems into viable/accepted solutions
* Advanced skills in customer relationship management and change management
* Ability to resolve conflict and foster teamwork
* Broad business knowledge
* Advanced persuasion and negotiating skills when working with internal/external customers
* Advanced knowledge of broad business practices
* Ability to travel 25-30%

Company Overview

Reinsurance Group of America, Incorporated (NYSE: RGA) is a leader in the global life reinsurance industry with approximately $2.9 trillion of life reinsurance in force and assets of $44.7 billion. We are one of the largest life reinsurance companies in the world.