再保险管理员 - LH
Reinsurance Administrator - LH
在Luminare Health，我们的员工是我们与众不同的原因。他们的专业技能、奉献精神和对服务卓越的热忱是公司成功的基础。
我们致力于通过有意识的发展机会、有意义的工作以及重视协作和持续改进的文化，帮助员工成长。加入Luminare Health，您将加入一个以使命驱动的团队，专注于让医疗保健变得更简单、更好、更实惠。
职位概述
再保险管理员负责准确及时地提交超额风险医疗索赔。在此职位上，您将与超额风险公司合作，解答问题、解决提交中的问题，并处理再保险的初步申诉。再保险管理员还将负责协调所有由超额风险公司提供的报告，并按要求分发。此职位需要高度关注细节，并能够在时间敏感的截止日期内工作。
识别并准备停损索赔提交，以获得客户超过特定免赔额的报销。与客户管理、理赔、财务及其他相关部门沟通。
识别并通知停损保险公司和客户，告知已达到特定免赔额50%的索赔人。
审查并处理所有因停损报销而退回的支票。
调查保险公司报销拒绝情况，并准备/提交反驳或向客户说明解释的通知。
向医疗理赔分析师和部门经理发送通知，指出可能需要在月底前处理所有索赔的特定索赔人。
其他所需/分配的职责。
所需的职位资格：
高中文凭或同等学历
1-2年医疗理赔经验，包括在停损（超额风险）理赔处理和提交方面的实际操作经验
熟练使用MS Word、Excel和Outlook
具备员工福利、第三方福利管理或再保险的相关知识
能够自我驱动，在较少监督的情况下工作
灵活；愿意接受变化并找到更高效的操作方式
与组织各层级人员具有良好的人际和沟通能力
能够有效呈现信息并回答问题
出色的时间管理能力；包括能够组织和协调多项任务，传达信息
查看英文原文
At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success.
We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable.
Job Summary
The Reinsurance Administrator is responsible for accurate and timely filing of excess risk medical claims. In this role, you will work collaboratively with excess risk companies to answer questions, resolve problems on filings, and handle initial appeals for reinsurance. The Reinsurance Administrator will also be responsible for coordinating all reporting that is supplied by the excess risk companies and distributing as required. This is a role that requires a high level of detail and the ability to work with time sensitive deadlines.
Identify and prepare stop loss claims submissions to obtain client reimbursement over their specific deductible amount. Communicate with Client Management, Claims, Finance and other impacted departments.
Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount.
Review and process all returned checks resulting from stop loss reimbursements.
Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client.
Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end.
Other duties as needed/assigned.
Required Job Qualifications:
High School Diploma or GED equivalent
1 – 2 years of medical claims experience, including hands-on experience with stop loss (excess risk) claims processing and submissions
Proficient experience with MS Word, Excel and Outlook
Previous knowledge of employee benefits, third party benefit administration or reinsurance
Self-directed individual that works well with minimal supervision
Flexible; open to change and finding better ways to operate efficiently
Excellent interpersonal and communication skills with all levels of an organization
Ability to effectively present information and respond to questions
Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency
Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data
Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
Required Job Qualifications:
- High School Diploma or GED equivalent
- 1 – 2 years of medical claims experience, including hands-on experience with stop loss (excess risk) claims processing and submissions
- Proficient experience with MS Word, Excel and Outlook
- Previous knowledge of employee benefits, third party benefit administration or reinsurance
- Self-directed individual that works well with minimal supervision
- Flexible; open to change and finding better ways to operate efficiently
- Excellent interpersonal and communication skills with all levels of an organization
- Ability to effectively present information and respond to questions
- Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency
- Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data
Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
EEO Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Pay Transparency Statement:
At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min to Max Range:
$18.07 - $33.92Exact compensation may vary based on skills, experience, and location.
Originally posted on Himalayas