Reinsurance Analyst

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

📋 Description

• Provide support for the daily operations within the reinsurance department.

• Conduct research and evaluate claims to obtain eligible stop-loss reimbursements.

• Identify and oversee Transplant Reinsurance claims and cases.

• Collaborate with the Medical Services’ transplant coordinator to establish and manage transplant cases and stages with AHCCCS.

• Review transplant logs and keep track of case stages and component payments.

• Input and maintain transplant reinsurance cases in PMMIS.

• Monitor and reconcile encounters against the PMMIS screen RI113 prior to component submission.

• Identify and manage Catastrophic Reinsurance claims and cases.

• Submit annual renewal letters for Catastrophic Reinsurance to AHCCCS Medical Management within 30 days of each contract year.

• Work with the Claims department to ensure the proper processing of Medicaid reinsurance claims.

• Ensure that reinsurance claims and CRNs are accounted for and associated according to the applicable rates.

• Comply with timely filing requirements.

• Review AHCCCS reinsurance reports on a monthly basis.

• Collaborate with Accounting and Data Warehouse to ensure accurate reinsurance reconciliation.

• Stay updated on AHCCCS reinsurance manuals, procedures, and requirements.

• Analyze high-dollar claims reports to confirm all reinsurance is accounted for.

• Provide motivation, support, guidance, and role-modeling to others or subordinates based on the level of responsibility.

• Execute additional tasks as assigned.

⛳️ Requirements

• Minimum of 2 years of experience in health plan reinsurance, claims unit, or AHCCCS administration (Level 1).

• Minimum of 3 years of experience in health plan reinsurance, claims unit, or AHCCCS administration (Level 2).

• High School Diploma or GED is required.

• Familiarity with healthcare and system design, including Oracle.

• Understanding of accounts payable and financial reporting.

• Strong analytical research and reporting skills.

• Knowledge of reinsurance recovery, recoupments, refund posting, and COB verification.

• Awareness of Medicaid and Medicare coverage and regulations.

• Comprehension of claims processing.

• Knowledge of AHCCCS guidelines and reinsurance requirements.

• Proficient in Excel, Word, Beginner SQL, MedMc, and QNXT.

• Ability to communicate effectively both orally and in writing.

• Capability to establish and maintain effective working relationships.

• Ability to perform duties at lower levels as part of career progression.

• Must be available to work a full-time schedule of at least 40 hours per week.

• A Bachelor’s degree in accounting, business, or a related field is preferred.

🏝️ Benefits

• Opportunity for remote work within the state of Arizona.

• Full-time employment (minimum of 40 hours per week).

• Flexible work location as part of AZ Blue’s Workability workforce strategy.

• Health insurance products and services provided by the employer.