S&S Health provides health administration services for employers and their employees, with a focus on managing healthcare costs while supporting access to quality care. Its end-to-end offering includes tools and resources to help employees find appropriate medical care at competitive prices, while helping businesses manage healthcare spending and support better health and financial outcomes.
Remote Reinsurance Claims Analyst
Handle stop-loss policy setup, claim documentation, filing, and reimbursement tracking remotely. Support Reflect Health’s benefits administration for employers and healthcare organizations.
Apraksts
- Review stop-loss policies and enter them accurately in claims systems.
- Check policy terms, including specific stop-loss (TLO) and aggregating specific deductibles.
- Gather and verify claim records, such as eligibility documents, medical records, subrogation details, and cost-containment reports.
- Help file routine, specific, aggregate, and complex stop-loss claims accurately and on time.
- Coordinate with Operations, Finance, and Sales on claim status and process updates.
- Check accounts for compliance with reporting requirements.
- Track premium payments and upload accurate data to systems on time.
- Assess claim refunds and allocate amounts to the appropriate filings.
- Explain claim decisions to internal teams and external clients using policy rules and group plan documents.
Prasības
- Experience processing medical claims, preferably in reinsurance.
- Familiarity with reinsurance policies and terms such as specific stop-loss (TLO) and aggregating specific deductibles.
- Strong critical thinking and the ability to assess and manage complex claims and data.
- Ability to handle multiple tasks, prioritize work, and work independently in a fast-paced setting.
- Intermediate proficiency with Microsoft Office 365, including Excel, Visio, and Word.
- Experience using claims management systems is a plus.
- Strong organization and careful attention to detail and accuracy.
- Excellent spoken and written communication skills.
- Strong analytical and problem-solving abilities.
- Must pass a comprehensive background check and drug test during hiring.