Reinsurance Claims Analyst: Stop-Loss & Data Specialist

S&S Healthcare; Cincinnati (OH); On-site; USD 70,000 - 90,000; Full time

Job summary

Reflect Health in Mason, OH is seeking a Reinsurance Claims Analyst to manage and coordinate stop loss claims, gather documentation, and drive accurate submissions. You will work with Operations, Finance, and Sales to ensure timely processing and clear communication with clients.

The role requires experience in medical claims processing, knowledge of reinsurance concepts, and strong analytical skills. This position offers a full-time on-site role with potential growth in a national organization.

Qualifications

• Experience in medical claims processing, with preference for reinsurance.
• Familiarity with reinsurance concepts such as TLO and Aggregating Specific Deductible.
• Strong analytical and problem-solving abilities.

Responsibilities

• Set up and manage stop loss policies in claims systems.
• Collect and verify documentation for stop loss claims.
• Assist in filing and tracking specific and aggregate claims.
• Collaborate with Operations, Finance, and Sales to update claim status.
• Monitor accounts for compliance and accurate premium remittance.
• Evaluate claim refunds and ensure proper application to claims.
• Communicate claim decisions clearly to internal and external stakeholders.

Skills

Medical claims processing

Reinsurance knowledge

Analytical skills

Project management

Microsoft Office 365

Tools

Claims management systems

Excel

Visio

Word

Job description

Reflect Health in Mason, OH is seeking a Reinsurance Claims Analyst to manage and coordinate stop loss claims, gather documentation, and drive accurate submissions. You will work with Operations, Finance, and Sales to ensure timely processing and clear communication with clients.

The role requires experience in medical claims processing, knowledge of reinsurance concepts, and strong analytical skills. This position offers a full-time on-site role with potential growth in a national organization.