„Brown & Brown Insurance“ yra nepriklausoma draudimo brokerių ir rizikos valdymo įmonė, teikianti paslaugas fiziniams asmenims ir įmonėms. 1939 m. įkurta bendrovė per daugiau kaip 500 padalinių tinklą teikia asmens ir komercinio draudimo, darbuotojų naudų bei nacionalinių draudimo programų paslaugas. Įmonėje dirba daugiau kaip 10 000 darbuotojų, ji veikia finansų ir draudimo sektoriuose, o savo darbo kultūroje pabrėžia įvairovę, įtrauktį ir priklausymo jausmą. „Brown & Brown Insurance“ akcijomis prekiaujama Niujorko vertybinių popierių biržoje, jų simbolis – BRO; įmonė plėtėsi vykdydama nuoseklią susijungimų ir įsigijimų strategiją.
Seasonal Senior Claims Auditor Consultant — Pennsylvania Remote
Oversee complex Employer Stop Loss claims for One80 Intermediaries, from adjudication and reserve recommendations to audit and resolution. The role focuses on high-cost medical claims, including transplants, oncology, catastrophic conditions, and specialty drugs.
Aprašymas
- Oversee and adjudicate complex Employer Stop Loss claims within assigned authority and under policy and contract terms.
- Interpret Stop Loss policies, certificates, plan documents, eligibility rules, deductibles, exclusions, reimbursement terms, and other contract provisions to determine claim eligibility and payment.
- Review high-value, complex, and unusual claims involving major medical expenses, transplants, oncology, catastrophic conditions, specialty drugs, and other costly services.
- Analyze claims data, medical records, eligibility details, provider records, invoices, and supporting documents to verify claim accuracy and reimbursement.
- Check claim adjudication for eligibility, deductibles, exclusions, benefits, payment calculations, and correct application of policy terms.
- Manage large-loss claims and prepare reports, analysis, recommendations, and escalations for the Vice President of Claims and other stakeholders.
- Assess and recommend reserves for large and complex claims using available information, expected liability, policy provisions, and reserving guidelines.
- Track large claims through their lifecycle and update reserves, claim estimates, and management reports.
- Audit claims before and after payment to find payment inaccuracies, processing errors, documentation gaps, and potential recoveries or corrections.
- Identify patterns, recurring errors, system problems, and process gaps that affect claim accuracy or financial performance, and recommend corrective steps.
- Coordinate with TPAs and external claims administrators to resolve complex issues, verify claim information, and maintain contract and administrative compliance.
- Handle inquiries and escalated claim matters from brokers, TPAs, plan sponsors, Underwriting, reinsurers, and other stakeholders.
Reikalavimai
- Bachelor’s degree.
- At least seven years of progressive claims experience, including substantial experience in Employer Stop Loss, medical claims, health benefits, or a related insurance setting.
- Experience handling complex, high-value medical claims.
- Experience auditing and adjudicating claims, reviewing payments, and analyzing claims.
- Experience interpreting insurance contracts, plan documents, and claims provisions.
- Experience managing large-loss claims and recommending reserves.
Privalumai
- Medical and prescription, dental, vision, life, and disability insurance
- Employee stock purchase plan, 401(k), student loan assistance, and tuition reimbursement
- Free mental health and enhanced advocacy services
- Paid time off
- Holidays
- Preferred partner discounts