Hm Life Insurance Company
Job Description :
This position is responsible for reviewing, evaluating and processing various Excess Risk and Reinsurance Claims. It is responsible for the conversation of positive client relationships, education and analysis of client claim losses as well as analysis of current issues regarding client activities with dissemination of this information to the HM Insurance Group management staff
- Display effective communication skills while providing counseling to clients and assisting with client service programs and interacting with internal departments
- Claims Analysis: Process daily incoming Stop Loss claims. Monitor, review and analyze various potential claims with emphasis on controlling losses through effective managed care. Frequent overnight travel nationally to assist Manager with performing client performance evaluations to assess the accuracy of client reports submitted to the Organization, efficiency of claim operations, and adequacy of systems and procedures. Evaluate various claims submitted by Third Party Administrators (TPAs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
- Client Interaction: Approve claim payments on behalf of multiple clients. Provide client counseling and support services. Assist in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the Organization
- Other duties as assigned or requested.
- High School Diploma/GED
- 5-10 years of relevant, progressive experience in the area of specialization
- Prior experience processing 1st dollar health insurance claims
- Prior experience with Medical Terminology
- Bachelor’s Degree
- Prior experience in a Stop Loss Claim Analyst role
- Intermediate to advance user of Excel
- Continuation of Coverage experience.
- Ability to communicate concise accurate information effectively
- Organizational skills
- Ability to manage time effectively
- Ability to work independently
- Problem Solving and analytical skills
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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