Claims Analyst International - Miami, FL

Morgan White Group • Coral Gables, FL

9d • Onsite

About The Position

The Claims Analyst reports to the Claims Department Manager of the MWG-International Division. The position is a non-exempt, hourly role and is located at 75 Valencia Avenue, Suite801, Coral Gables, Florida 33134.

GENERAL JOB DUTIES AND RESPONSIBILITIES:
To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Requirements

• Requires high school diploma or general education degree or equivalent or 1 year of related experience.
• Medical knowledge to be able to analyze a medical claim submitted to determine eligibility.
• Communication skills - verbal, written and listening skills
• Knowledge of Microsoft outlook, excel and word.
• Each employee must pass a drug screen.
• Reports must be received from criminal background investigation and review of work references.
• Must be capable of maintaining regular attendance.
• Must be capable of performing the essential job functions of the position, with or without reasonable accommodations
• BILINGUAL REQUIRED: Must be able to read, write, and speak English and Spanish.
• Must have basic typing skills
• Must be able to work as scheduled.
• Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
• Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday.
• Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs.

Responsibilities

• Processing and adjudication.
• Analyzing the claims to properly adjudicate it according to the policy benefits and limitations.
• Responsible for all emails and phone calls with clients and agents regarding the assigned cases.
• Responsible for investigating any medical information needed to properly process a claim by requesting medical records or any other document needed to providers and/or insureds (USA, Latin American and/or the Caribbean) to make a determination on the claim submitted.
• Responsible for writing and submitting letters of denial to insureds, letters of exclusionary riders or cancellation of coverage to the Insured when necessary.
• Prepare medical evaluations for cases on excess of $100.000.00 or on any cases in which a retroactive exclusionary rider needs to be applied.
• Communicate to Insured on a formal letter of any Lloyd's decision regarding an appeal of a

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees