Client Financial Analyst
About The Position
Responsible for financial claims expense invoicing, reporting, analysis and forecasting. Prepares financial claims expense invoices, reports and operating trends. Prepares financial claims expense statements through the coordination of the month end close and reporting process as well as applicable analysis and accounting research. Research and analysis could include root cause analysis, resolution of inquiries and/or activities, which may include claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contract and/or program engagement to support finance and/or business operation. Responsible for developing, utilizing, interpreting, and/or reporting claims expense financial data as it relates to historical claims expense reporting, forecasting and/or estimating the future trends in health care costs.
Requirements
- Bachelor's degree or advanced degree (where required)
- 3+ years of experience in related field
- In lieu of degree, 5+ years of experience in related field
Nice To Haves
- Experience analyzing and interpreting data to support business decisions.
- Experience presenting information to clients, customers, or business stakeholders.
- Proficiency with Microsoft Excel and other data analysis tools.
- Strong written and verbal communication skills.
- Demonstrated ability to manage multiple priorities and deadlines simultaneously.
- Background working with healthcare, insurance, claims, or benefits-related data.
- Proven experience with stop-loss coverage concepts preferred.
- Experience supporting external clients or customer-facing business functions.
Responsibilities
- Develop, analyze, interpret, report, and present historical and/or forecasted financial claims expense and stop loss coverage information.
- Prepare claims expense financials, estimated claim expense and financial forecasts. Prepare financial and business-related analysis and research.
- Coordinate and direct the preparation of stop loss coverage for employer groups or stop loss vendors based on actual high dollar claims and/or claimants’ performance, previous stop loss credits, estimated claims expense, expense reports and other factors.
- Prepare reports and analysis for various audiences such as Self-Funded Groups (Employer), Stop Loss Vendors, Sales, Underwriting, etc. Responsible for monthly variance analysis (at employer group level or consolidated company level).
- Act as a consultant for management on financial policy, procedure and application as well as historical, plan and forecasting.
- Review and check for accuracy of various internal and external reports, such as membership, commissions, and the impact of large claims on the administrative services and stop loss coverage for use in financial analysis.
- Prepare employer group transactions and Statement of account reconciliations, assist with the monthly, run out and final close out activities, prepare schedules and other general accounting functions.
- Process a variety of client transactions that may include suspended and/or hold of claims, Run out administrative fees, and/or employer group settlement.
- Determine benefit eligibility for stop loss coverage on claims for specific claimants based on contract terms. Includes a variety of stop loss vendor transactions such as inquiries regarding utilization, provider information, medical reviews, Leave of absence language, COBRA benefits, and plan documentation.
- Act as a point of contact for internal and/or external audits and projects as necessary; assist in planning, scoping, testing, training and implementation.
- Perform quality reviews of operational inquiries to determine the accuracy of information provided and ensure employees are functioning at the expected level of service to enhance customer satisfaction. Communicate the results of the reviews to improve individual and overall performance and make recommendations for coaching and training as necessary.
- Handle more complex problems of eligibility and documentation with producers. May provide additional information to underwriting staff when submitting referrals for exception consideration.
Benefits
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
