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Ryan Specialty Boston, United StatesPress Tab to Move to Skip to Content Link · Select how often (in days) to receive an alert: · Stop Loss Underwriter · JOB SNAPSHOT: · Employee Type: · Full-Time · Location: · Pembroke, MA, US, 02359 · Job Type: · Administrative · Secondary Location: · Years of Experience: · ...
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Claims Manager- Stop-Loss - Boston, United States - Jencap
Description
Why 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.
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 Manager
supports medical insurance customers (including administrators, MGUS, brokers) by confirming eligibility, determining insurance coverage, examining and resolving medical stop loss claims, documenting actions, maintaining quality customer service, ensuring compliance.
Responsibilities:
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.
Maintains quality client service by responding timely and accurately to client inquiries maintaining client expected turn-around time
Prepares standard and ad hoc reports
Maintains confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Requirements
:
College degree or a minimum of five (5) years medical stop loss claims processing.
Strong written and verbal communication skills.
Working knowledge of David Young (ESL System) and or Kevin Ugan system.
Flexibility to handle multiple priorities while maintaining high level of professionalism.
Must be able to work well independently or in a team environment.
Knowledge of CPT/HCPC, Revenue and ICD9 to ICD10 coding procedures and guidelines
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.
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors.
. Discretionary incentive compensation may be awarded. Jencap also offers a range of benefits and programs, based on eligibility, which currently include but are not limited to; comprehensive health care coverage, a 401k plan, and tuition reimbursement. Jencap is an emerging and rapidly growing leader in the industry and as such, we approach talent acquisition as an opportunity to identify the best talent. Therefore, the level of the role and compensation may vary depending upon the best available candidate.
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.
