Claims Examiner II A&H

American International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and services that help businesses and individuals protect their assets and manage risks.

We’re also committed to making a positive difference for our colleagues and in the communities where we work and live. We encourage colleagues to give back to the causes they care most about, supporting these efforts through our Volunteer Time Off and Matching Grants Programs.

General Insurance is a leading provider of insurance products and services for commercial and personal insurance customers. It includes one of the world’s most far-reaching property casualty networks. General Insurance offers a broad range of products to customers through a diversified, multichannel distribution network.

The claims function is meant to be a partner to the business segments, offering support, expertise and partnership. The existing diversity of the business portfolio demands from the claims role specialized expertise in the different business areas. The A&H claims team works with the business to support a wide array of products and offerings, through a complex and highly demanding distribution force and network. Claims has the responsibility of delivering and materializing the product offer and promise. In the case of A&H this opportunity is given in even the most sensible and highly complex situations where the health and well being of our insureds and clients is touched and where we can make a significant difference at that level.

What you need to know:

The primary purpose of the job is to investigate, evaluate, negotiate, and settle the complex/express claims cases by collecting and analyzing data according to policy application and/or contract provisions.  Determine whether to accept or deny a claim based on all documentation received. Typical claims include policy cancelations due to non-pay denial letter required. 

Your contribution at AIG

The employee will handle a monthly average of 60 claims new and 60-90 outstanding according to the staffing model.

1. Functional Responsibilities:

• Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate for high value complex claims

• Ensuring effective vendor and litigation management on Complex claims within a personal allocation, including demonstrable savings

• Reporting key claims messages to their Team Manager and to internal stakeholders

• Broader internal / external stakeholder communication where required, as (LoB) technical claims expert and thought leader

• Delivery of technical training to colleagues and external contacts as appropriate

• Assist in continuous improvement across the region through support for the Quality Assurance / Regional Audit processes (potentially assisting Team Manager to complete monthly quality assurance reviews?)

• Ensure adherence to best practice procedures for (LoB) Complex claims, consistent with global best practice.

• Handle higher level of complexity claims Complex losses within authority limits

2. Accountabilities:

• Timely, accurate and customer focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expense

• Effective communication and management of key advanced Complex claims and (LoB) portfolio messages to internal stakeholders and customers/clients.

• Financial control through consistent reserve and other financial transaction discipline

• Accurate and consistent policy interpretation.

• The target for this role to develop as a subject matter expert rather than people manager development path. However, mentoring and assistance to management duties and responsibilities are part of the role.

 3. Leadership Skills

•  Excellent communication skills, both written & verbal

• Good presentation skills and file knowledge

• Time management – ability to manage & prioritize workload and diary management

• Ability to contribute effectively within a team environment and with internal/external stakeholders at all levels

• Ability to assist with technical training to team claim handlers as required

• Ability to influence claims and non-claims stakeholders to effectively direct claims strategy

 4. Technical Skills and Expertise

•  Well-developed/Advanced expertise and knowledge in (LoB) most technically complex claims topics (as listed over page).

• Policy language skills enabling accurate and consistent policy wording interpretation.

• Basic to medium knowledge of legal / regulatory and litigation / procedural requirements for their line of business

• Experience in negotiation, mediation, arbitration, and ADR skills on higher value complex claims is a plus

• Medium to basic experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement

• Experience:

  • 0-3 years of claims handling or case management for medical or personal accident claims portfolio

  • 0-2 years of handling and managing medical service providers networks, cost containment strategies and continuous improvement strategies.

  • Basic policy wording interpretation and claims resolution on personal accident or medical expenses policies.

  • Minimum to medium experience in the handling of complex case management (e.g. cancer, etc.).

• Along with technical skills required for the job, soft skills like effective broker engagement, teamwork, proactive claims management, effective time management/priorization, calendar organization.

Effective analytical and attention to detail.

Reimagining insurance to make a bigger difference to the world

American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world’s most far-reaching property casualty networks. It is an exciting time to join us — across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.

Welcome to a culture of belonging

We’re committed to creating a culture that truly respects and celebrates each other’s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through our flexible work arrangements, diversity and inclusion learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The diversity of our people is one of AIG’s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.

AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.

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