Reinsurance Analyst

JOB DESCRIPTION

SUMMARYThis position reports to the Manager of Claims in a production environment and is responsible for supporting the various departments, within the company, to provide claims services to reinsurance carriers in order to obtain reimburse for excess loss medical claims on behalf of the Company’s Trust and Employer Groups associated under Third Party Administrator (TPA). This position is also the subject matter expert for the team in reviewing supporting documentation, client, and reinsurance reporting.

Qualifications

• High school education or equivalent and minimum of two (2) to five (5) years of experience as a medical / dental claims auditor / investigator and / or medical insurance account management / sales.
• Basic knowledge of word processing, spreadsheet, presentation media and end-user office software.
• Ability to work under pressure and adapt to a changing environment.
• Knowledge and experience of International Statistical Classification of Diseases and Related Health Problems (ICD-9, ICD-10), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS II & III), coordination of benefits, Medicare, Hospital claims, surgery claims, subrogation, and accident claims.
• Proficient with terminology comprehension.
• Good verbal and written communication skills.
• Working knowledge of Employee Retirement Income Security Act of 1974, (ERISA) claims processing / adjudication guidelines.
• Exceptional organizational, time management, critical thinking, and problem-solving skills.
• Knowledge of client specific, potential, and aggregate reporting under reinsurance a plus

Duties And Responsibilities

Specific Claim Submission

Reporting and End of Contract Review

Quality Results

Other

Physical Demands / Work Environment

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.