Reinsurance Business Analyst

PacificSource Health Plans

2d • Hybrid

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Serve as a subject matter expert in reinsurance administration for PacificSource and its self-funded clients. This role is responsible for managing high-dollar reinsurance cases by auditing and adjudicating claims, ensuring accurate documentation. The analyst interprets claims and financial data to identify reimbursement opportunities that exceed reinsurance thresholds. In addition, the role collaborates with clients and stakeholders to resolve inquiries and oversee multiple reinsurance products across various states and markets.

Requirements

• A minimum of 3 years of claims processing or business analysis experience required.
• High School Diploma or equivalent required.
• Demonstrated expert-level understanding of self-funded products, plan designs, and health insurance terminology.
• Strong ability to interpret, understand, and apply complex health contracts and reinsurance requirements.
• High-level knowledge of medical terminology and proficiency in ICD-10 and CPT coding.
• Exceptional ability to balance multiple complex projects and accomplish tasks accurately under pressure, consistently meeting deadlines.
• Proven capacity to be self-motivated, think critically, and work independently with minimal supervision.
• Superior written and verbal communication skills, with the ability to interact professionally and effectively with diverse internal and external customers.
• Unwavering accountability for the quality and accuracy of all documents, files, and records used to substantiate reinsurance cases.
• Intermediate to advanced proficiency in Microsoft Office Suite, particularly Excel, Word, and Outlook, along with 10-key accuracy.

Nice To Haves

• Marketing and/or reinsurance administration experience is preferred.

Responsibilities

• Maintain expert-level understanding of reinsurance contract terms and provisions; adapt administration processes for new, renewing, and custom self-funded groups.
• Participate in group meetings to provide guidance on reinsurance requirements and processes.
• Analyze complex claims and reporting data to identify potential reinsurance cases; initiate Advanced Funding requests when applicable.
• Audit and adjudicate claims to determine reimbursement eligibility; reconcile discrepancies and ensure accurate documentation.
• Prepare and submit comprehensive claims packets to carriers; track submissions and manage appeals for denied or pending claims.
• Accurately post reimbursements and maintain detailed claims accounting, aggregating-specific, and aggregate reinsurance claims.
• Generate and audit manual and system-based reports for internal and external stakeholders, ensuring accuracy across overlapping contract scenarios.
• Conduct regular reviews of unpaid claims and facilitate timely adjudication during contract closeout periods.
• Utilize and interpret various internal reports (e.g., Large Claims, Pre-payment Audit, Reinsurance Reports) to support reinsurance operations.
• Communicate effectively and professionally, both verbally and in writing, with carriers, clients, agents, and internal departments.
• Actively participate in team meetings and daily team Visual Board huddles.
• Consistently meet department and company performance and attendance expectations.
• Adhere strictly to PacificSource's privacy policy and all HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned to support department objectives.

Benefits

• Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED