Reinsurance Claim Analyst

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

📋 Description

• Review stop loss policies and ensure they are set up correctly within claims management systems.

• Validate policy terms and conditions, including Specific Stop Loss (TLO) and Aggregating Specific Deductible.

• Gather and verify documentation for stop loss claims, which includes eligibility documentation, medical records, subrogation details, and cost containment reports.

• Assist in the timely and accurate submission of routine, specific, aggregate, and complex stop loss claims.

• Collaborate with Operations, Finance, and Sales regarding claim status and communication throughout the claims process.

• Monitor accounts to ensure compliance with reporting requirements.

• Track premium remittances and guarantee timely and accurate uploads of system data.

• Assess claim refunds and properly allocate funds to their respective claim filings.

• Clearly communicate claim decisions to internal teams and external clients in accordance with policy guidelines and group plan documentation.

⛳️ Requirements

• Experience in processing medical claims, ideally within the reinsurance sector.

• Knowledge of reinsurance policies and terms, including Specific Stop Loss (TLO) and Aggregating Specific Deductible.

• Strong critical thinking abilities and capacity to evaluate and manage complex data and claims.

• Proven track record of managing multiple responsibilities, prioritizing tasks, and working independently in a fast-paced setting.

• Intermediate proficiency in Microsoft Office 365, including Excel, Visio, and Word.

• Experience with claims management systems is advantageous.

• Highly organized with a strong attention to detail and accuracy.

• Excellent verbal and written communication capabilities.

• Strong analytical and problem-solving skills.

• Must undergo a comprehensive background check and drug testing as part of the hiring process.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health and wellness benefits package.

• Opportunities for professional development and career advancement.

• Flexible work arrangements and a supportive work environment.