Reinsurance Claim Analyst - REMOTE

S&S Healthcare•Cincinnati, OH

2d•$60,000 - $80,000•Remote

About The Position

The Reinsurance Claims Analyst plays a crucial role in the management of reinsurance processes, tracking, and reporting for our clients. This position will support the timely filing of reimbursement claims and collaborate with multiple departments to ensure accurate processing and documentation. The Reinsurance Claims Analyst will be responsible for coordinating data, ensuring compliance, and maintaining strong relationships with both internal and external stakeholders.

Requirements

Experience in medical claims processing, with a preference for experience in reinsurance.
Familiarity with reinsurance policies and terms such as TLO (Specific Stop Loss), Aggregating Specific Deductible, and other related concepts.
Strong critical thinking skills and the ability to effectively evaluate and manage complex data and claims.
Proven ability to manage multiple tasks, prioritize responsibilities, and work independently in a fast-paced environment.
Intermediate proficiency with Microsoft Office 365, including Excel, Visio, and Word.
Highly organized with a keen attention to detail and accuracy in all aspects of work.
Excellent verbal and written communication skills, with the ability to present complex information in an understandable manner to both internal and external parties.
Strong analytical and problem-solving skills, with the capacity to articulate issues and propose effective solutions.

Nice To Haves

Experience with claims management systems is a plus.

Responsibilities

Review stop loss policies and ensure accurate setup within claims management systems.
Verify policy terms and conditions, including TLO (Specific Stop Loss) and Aggregating Specific Deductible.
Collect and verify all necessary documentation for stop loss claims, including eligibility documentation, medical records, subrogation details, and cost containment reports.
Ensure all information is accurate and timely for reimbursement submissions.
Assist in managing specific and aggregate claims submissions, ensuring the timely and accurate filing of both routine and complex stop loss claims.
Work with internal departments, including Operations, Finance, and Sales, to provide updates on claim status and ensure seamless communication throughout the claims process.
Regularly monitor accounts to ensure compliance with reporting requirements.
Track premium remittances, and ensure accurate data is uploaded to the system in a timely manner.
Evaluate claim refunds and ensure that dollars are properly applied to respective claims filings.
Articulate claim decisions clearly to both internal teams and external clients based on policy guidelines and group plan documentation.