- Coordinates directly with Senior Claims Analyst, Manager, and Managing Director.
- Guides claims admin staff as necessary.
- Coordinates closely with Policy Issuance and Accounting departments.
- Processes/reviews 50% notifications
- Establishes proof of loss by reviewing medical documentation presented, requesting additional information from sources such as administrator, broker, hospital, physician, etc.
- Adjudicates claims in medical stop loss system (ESL) and or (UGAN) approving, denying based on compliance with SPD and Stop loss policy.
- Applies Anti-Fraud Guidelines as appropriate.
- Claims authority determined based upon experience and client requirements.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and California Fair Claims Settlement Practices,
- Knowledge of CPT/HCPCS, Revenue and ICD9 to ICD10 coding procedures and guidelines
- Minimum of two (2) plus years medical stop loss claims processing
- Flexibility to handle multiple priorities while maintaining high level of professionalism. Must be able to work well independently or in a team environment.
- Proficiency using Microsoft office products.
- Working knowledge of David Young (ESL System) and/or Kevin Ugan system.
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Claims Analyst - Danvers, United States - Jencap
Description
Job Description
Job DescriptionWhy Jencap? We are one of the largest wholesale insurance intermediaries in the United States with expertise in wholesale brokerage, binding authority, and program management. The common thread woven throughout our success story is our collaborative and driven team of people. Our teams are empowered and work together to find solutions. We have a passion culture – with teamwork, collaboration and a focus on growing individuals and giving them the tools & development opportunities to have a successful career.
HRMP, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We provide a variety of services and solutions within the insurance market such as stop-loss program administration, group life and medical conversions, auditing services, back office or run-out administration, quota share and excess medical reinsurance.
HRMP, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We provide a variety of services and solutions within the insurance market such as stop-loss program administration, group life and medical conversions, auditing services, back office or run-out administration, quota share and excess medical reinsurance.
The Claims Analyst will work a hybrid schedule reporting to our Jencap office in Danvers, MA. We are also accepting remote applicants depending upon location.
Responsibilities:
Requirements:
Want the opportunity to build something new? Expand your knowledge and stretch your experience through new and emerging risks? Have your voice heard, your skills properly applied, and to add tangible value to an organization? You're in the right place.
Jencap is dynamic, bold, tenacious, and trusted in the industry. Here, you are not just one of the many, you are one of us. We truly are better together.
Jencap is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin or citizenship status, sexual orientation, gender identity or expression, pregnancy, marital or familial status, disability status, medical condition, genetic information, military or veteran status, political affiliation, or any other characteristic protected by law. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard, as we believe that that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients.
