Reinsurance Claims & Policy Specialist

S&S Healthcare; Cincinnati (OH); Remote; USD 60,000 - 80,000; Full time

Job summary

Reflect Health in Cincinnati is seeking a Reinsurance Claims Analyst to support timely filing and accurate processing of stop loss claims. You will coordinate with Operations, Finance, and Sales to ensure compliance and data integrity.

The role requires experience in medical claims processing, familiarity with stop loss terms, and strong analytical and communication skills. The successful candidate will manage documentation, submissions, and reporting to help clients achieve better outcomes.

Qualifications

• Experience in medical claims processing, with a preference for reinsurance.
• Familiarity with reinsurance policies and terms such as TLO (Specific Stop Loss) and Aggregating Specific Deductible.
• Strong analytical and project management abilities.
• Excellent communication and attention to detail.
• Ability to work independently in a fast-paced environment.

Responsibilities

• Reinsurance policy setup and management in claims systems; verify TLO and Aggregating Specific Deductible.
• Claims documentation and submission: collect and verify eligibility documentation, medical records, subrogation details.
• Claims filing and tracking: manage submissions for routine and complex stop loss claims.
• Cross-department collaboration with Operations, Finance and Sales to update claim status.
• Account monitoring and reporting: track premium remittances and ensure timely data uploads.
• Financial application of claims: evaluate refunds and apply dollars correctly.
• Internal and external communication: explain claim decisions to stakeholders.

Skills

Analytical skills

Problem-solving

Communication skills

Project management

Attention to detail

Tools

Excel

Microsoft Office 365

Visio

Word

Claims management systems

Job description

Reflect Health in Cincinnati is seeking a Reinsurance Claims Analyst to support timely filing and accurate processing of stop loss claims. You will coordinate with Operations, Finance, and Sales to ensure compliance and data integrity.

The role requires experience in medical claims processing, familiarity with stop loss terms, and strong analytical and communication skills. The successful candidate will manage documentation, submissions, and reporting to help clients achieve better outcomes.