Reinsurance Administrator - LH

Luminare Health

8d•$18 - $34•Remote

About The Position

The Reinsurance Administrator is responsible for accurate and timely filing of excess risk medical claims. In this role, you will work collaboratively with excess risk companies to answer questions, resolve problems on filings, and handle initial appeals for reinsurance. The Reinsurance Administrator will also be responsible for coordinating all reporting that is supplied by the excess risk companies and distributing as required. This is a role that requires a high level of detail and the ability to work with time sensitive deadlines. Identify and prepare stop loss claims submissions to obtain client reimbursement over their specific deductible amount. Communicate with Client Management, Claims, Finance and other impacted departments. Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount. Review and process all returned checks resulting from stop loss reimbursements. Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client. Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end. Other duties as needed/assigned.

Requirements

High School Diploma or GED equivalent
1 – 2 years of medical claims experience, including hands-on experience with stop loss (excess risk) claims processing and submissions
Proficient experience with MS Word, Excel and Outlook
Previous knowledge of employee benefits, third party benefit administration or reinsurance
Self-directed individual that works well with minimal supervision
Flexible; open to change and finding better ways to operate efficiently
Excellent interpersonal and communication skills with all levels of an organization
Ability to effectively present information and respond to questions
Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency
Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data

Responsibilities

Accurate and timely filing of excess risk medical claims.
Work collaboratively with excess risk companies to answer questions, resolve problems on filings, and handle initial appeals for reinsurance.
Coordinate all reporting supplied by excess risk companies and distribute as required.
Identify and prepare stop loss claims submissions to obtain client reimbursement over their specific deductible amount.
Communicate with Client Management, Claims, Finance and other impacted departments.
Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount.
Review and process all returned checks resulting from stop loss reimbursements.
Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client.
Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end.