• Job Description

  Req#: 1195
  Employer Industry: Insurance
  
  Why consider this job opportunity:
  - Opportunity for career advancement and growth within the organization
  - Engaging role with responsibilities in claims analysis and resolution
  - Supportive work environment focused on collaboration
  - Chance to work closely with various stakeholders, including plans and external vendors
  - Involvement in optimizing claim processes and policies
  
  What to Expect (Job Responsibilities):
  - Review, analyze, manage, and adjudicate claims across applicable lines of business
  - Assist in the development and implementation of new materials, guidelines, and procedures
  - Research and resolve claim issues by identifying problems and assembling necessary documentation
  - Route advanced issues to the Director, Claims and Clinical, and other relevant parties when risks are identified
  - Analyze, summarize, and report findings related to claims data
  
  What is Required (Qualifications):
  - Bachelor's degree required
  - Knowledge of current state issues, regulations, and industry trends as they relate to claims
  - Proficiency with Microsoft Office Suite, with advanced skills in Excel required
  - Excellent verbal and written communication skills
  - Experience handling large volumes of stop-loss claims preferred
  
  How to Stand Out (Preferred Qualifications):
  - Industry designations preferred
  - Knowledge of COB (Coordination of Benefits), Medicare, HIPAA, CPT/HCPC, ICD-9/10, COBRA, and benefit plan interpretation
  - Understanding and experience with data analytics preferred
  - Knowledge of medical insurance stop-loss contracts, excess of loss reinsurance, and self-funded plans preferred
  - Familiarity with Microsoft Access is beneficial, but not required
  
  #Insurance #ClaimsAnalysis #CareerOpportunity #DataAnalytics #Collaboration
  
  We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
  We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.

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