Financial Claims Associate

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Execute financial claims expense invoicing, reporting, analysis, reimbursement assessments, and forecasting.

• Generate financial claims expense invoices, weekly statements, forecasts, schedules, and materials for month-end closure.

• Examine and present both historical and projected claims expense data along with stop loss coverage insights.

• Develop loss coverage financial reports for employer groups and stop loss vendors.

• Assess employer group subgroup expenditures to ensure adherence to Administrative Agreements.

• Create reports and variance analyses for employer groups, stop loss vendors, Sales, Underwriting, and various stakeholders.

• Validate manual transaction fees and contractual modifications.

• Generate estimates and adjustments for both new and existing business.

• Reconcile account statements and aid in monthly run-out and final close-out procedures.

• Gather data for internal and external audits.

• Manage claims-related client transactions, including claim holds, run-out administrative fees, and employer group settlements.

• Assess stop loss coverage eligibility for claims in accordance with contract stipulations.

• Investigate utilization, provider details, medical reviews, leave-of-absence provisions, COBRA benefits, and plan documentation.

• Conduct quality reviews of operational inquiries to guarantee accurate information and satisfactory service standards.

⛳️ Requirements

• Bachelor’s degree or advanced degree (if required), or a minimum of 3 years of relevant experience in lieu of a degree.

• 0-2 years of experience in a relevant field.

• Capability to execute financial claims expense invoicing, reporting, analysis, reimbursement assessments, and forecasting.

• Proficiency in preparing financial claims expense reports, weekly invoices, statements, forecasts, and reconciliations.

• Competence in researching claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contracts, and program engagement.

• Skill in analyzing stop loss coverage, high-dollar claims, claimants' performance, trends, and contractual modifications.

• Ability to ascertain stop loss benefit eligibility based on contract stipulations.

• Capacity to support audits, variance analyses, quality reviews, and client transactions.

🏝️ Benefits

• Work-life balance, flexibility, and autonomy.

• Medical, dental, and vision coverage.

• Health and wellness programs.

• Parental leave and support.

• Adoption and surrogacy assistance.

• Career development programs.

• Tuition reimbursement for continued education.

• 401(k) match with an annual company contribution.

• Paid Time Off (PTO).

• Annual Incentive Bonus.

• Remote work with occasional in-office visits each year for meaningful interactions.