Financial Claims Associate

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

📋 Description

• Execute invoicing for financial claims expenses, along with reporting, analysis, reimbursement assessments, and forecasting.

• Create financial claims expense reports, weekly invoices, statements, and materials for month-end closures.

• Provide insights through reporting, trend analysis, and research on administrative services and stop loss coverage.

• Develop, analyze, interpret, invoice, report, and present both historical and projected financial claims expense and stop loss coverage data.

• Prepare financials related to loss coverage for employer groups or stop loss providers.

• Review expenditures of employer group subgroups to ensure compliance with Administrative Agreements.

• Generate reports and analyses for Self-Funded Groups, Stop Loss Vendors, Sales, and Underwriting.

• Assist in conducting monthly variance analysis at both employer group and consolidated company levels.

• Verify and identify manual transaction fees and contractual adjustments.

• Prepare estimates and adjustments for both new and existing business ventures.

• Prepare reconciliations of statement-of-account, schedules, monthly run-out, and final closing activities.

• Compile necessary data for internal and external audits.

• Process client transactions, including claim suspensions or holds, run-out administrative fees, and employer group settlements.

• Assess stop loss benefit eligibility for specific claimants based on the terms of contracts.

• Assist with quality reviews of operational inquiries to ensure the accuracy of information and adherence to expected service levels.

⛳️ Requirements

• Bachelor's degree or an advanced degree where required.

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

• Alternatively, 3+ years of experience in a related field may substitute for a degree.

• Familiarity with financial claims expense invoicing, reporting, analysis, reimbursement, and forecasting.

• Capability to prepare financial claims expenses, weekly invoices, and statements through to month-end closure.

• Proficiency in conducting research, root cause analysis, and resolving inquiries.

• Ability to analyze claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contracts, and program engagement.

• Competence in determining eligibility for stop loss coverage benefits based on contractual terms.

🏝️ Benefits

• Annual Incentive Bonus tied to the achievement of corporate goals and individual performance.

• 401(k) plan with employer matching contributions.

• Paid Time Off (PTO).

• Competitive health benefits.

• Wellness programs.

• Comprehensive Total Rewards package.