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    Claims Analyst - Danvers, United States - Jencap

    Jencap
    Jencap Danvers, United States

    2 weeks ago

    Default job background
    Description

    HRM
    P

    , 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

    provid

    e

    a variety of services

    and solutions

    within the insurance market such as stop-loss program administration, group life

    and medical

    conversion

    s

    , auditing

    services

    ,

    back office or

    run-out administration

    ,

    quota share and excess medical reinsurance.


    HRM
    P

    , 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

    provid

    e

    a variety of services

    and solutions

    within the insurance market such as stop-loss program administration, group life

    and medical

    conversion

    s

    , 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:
    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


    Requirements:
    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.

    #J-18808-Ljbffr
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