Claims Examiner II A&H

Claims Examiner II A&H 

Who we are 

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. 

Get to know the business  

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. 

About the role 

What you need to know: 

• The main responsibility of the Claims Analyst II is to execute a specific opinion, investigating, evaluating, negotiating and resolving claims assigned for accident coverage, for attention that may be derived from:  

1. Reimbursement of medical expenses due to national and foreign accidents. 

2. Bodily injuries that could cause the accidental death of a client leading to compensation 

3. Compensation for diagnosis of serious illnesses, etc. by collecting information and analyzing data in accordance with the terms and conditions of the policy.  

4. Compensation for funeral expenses. 

5. Compensation for traveler policy claims (lost luggage, missed flights, flight delays, reimbursement of medical expenses due to accidents abroad, etc.). 

• This position is also responsible for determining coverage and appropriately handling denial and complaint situations in accordance with local regulations, applicable laws and practices.  

• Is responsible for identifying and ensuring that the claimant follows up on the compliance portion of each personal accident claim.  

Your contribution at AIG 

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

 Duties and Responsibilities 

1. Functional Responsibilities: 

• Work with the verification area to detect warning signs. 

• Manage queries on the handling of key complaints; coverage determination, quantum analysis, and legal liability assessment, where applicable for complex, high-value claims 

• Ensure effective supplier and litigation management of complex claims within a personal assignment, including demonstrable savings. 

• Report key complaint messages to your team manager and internal stakeholders. 

• Broader communication with internal and external stakeholders where necessary, such as technical claims expert (LoB), medical providers, and thought leader. 

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

• Assist in continuous improvement across the region through supporting Regional Quality Assurance/Audit processes (potentially assist the Team Manager in completing monthly quality assurance reviews?) 

• Ensure compliance with best practice procedures for complex claims (LoB), consistent with global best practices. 

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

• Maintain the record of timely reservations. 

• Contribute to the containment of the cost of the business line based on the usual expense in each recovery 

• Keep updating each claim within periods no longer than 90 days. 

2. Accountabilities: 

• Timely, accurate and customer-focused claims resolution, minimizing compensation exposure and mitigating legal and supplier expenses. 

• Effectively communicate and manage key advanced complex claims and portfolio (LoB) messages to internal stakeholders and customers. 

• Financial control through consistent reserves and other disciplines in financial transactions. 

• Accurate and consistent policy interpretation. 

• The objective of this role is to develop as a subject matter expert. 

 4. Technical Skills and Expertise 

• Experience on Insurance sector of at least 1 year in the management of personal accident claims, traveler policies or knowledge in the designation of beneficiaries in legal status.  

• Knowledge of sentencing processes in claims for bodily injuries, deaths and diagnoses of serious illnesses.  

• Basic knowledge of medical language (injury diagnoses).  

• Basic knowledge of the General Conditions of Personal Accidents.  

• Experience in administration and file management.  

• Basic knowledge of accounts payable management.  

What we’re looking for: 

• Formal education: Graduate in Administration but with experience in health areas. Uncompleted or completed career in health areas (doctors, nurses, paramedics or some branch of medicine) 

• 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. 

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

• Soft Skills: Ability to prioritize and multitask effectively in a fast-paced environment. Requires competency in desk management, telephone "etiquette," time management, and dealing with difficult customers. Experience in effectively following up on technical claims audit recommendations and continuous improvement in claims management. Commitment to the operation to achieve the objectives. Effective communication with clients and openness to teamwork. 

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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.

AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities.  If you believe you need a reasonable accommodation, please send an email to candidatecare@aig.com.  

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