Reinsurance Claims Specialist

S&S Healthcare; Oregon; Hybrid; USD 60,000 - 90,000; Full time

Job summary

Reflect Health is seeking an experienced claims professional to support stop loss claim management and cross-department collaboration. The role emphasizes accuracy in documentation, timely submissions, and strong communication with internal teams and external clients.

The candidate should have experience in medical claims processing, familiarity with reinsurance terms like TLO and Aggregating Specific Deductible, and solid Excel/Office 365 skills.

Qualifications

• Experience in medical claims processing, with a preference for experience in reinsurance.
• Familiarity with reinsurance policies and terms such as TLO (Specific Stop Loss), Aggregating Specific Deductible.
• Strong critical thinking skills and the ability to effectively evaluate and manage complex data and claims.
• Proven ability to manage multiple tasks, prioritize responsibilities, and work independently in a fast-paced environment.
• Intermediate proficiency with Microsoft Office 365, including Excel, Visio, and Word. Experience with claims management systems is a plus.
• Detail-oriented with a keen attention to detail and accuracy in all aspects of work.
• Excellent verbal and written communication skills, with the ability to present complex information clearly.
• Strong analytical and problem-solving skills, with the capacity to articulate issues and propose effective solutions.

Responsibilities

• Reinsurance Policy Setup and Management: Review stop loss policies and ensure accurate setup within claims management systems.
• Claims Documentation and Submission: Collect and verify all necessary documentation for stop loss claims and timely reimbursement submissions.
• Claims Filing and Tracking: Assist in managing specific and aggregate claims submissions, ensuring timely filing of routine and complex claims.
• Cross-Department Collaboration: Work with Operations, Finance, and Sales to provide updates on claim status.
• Account Monitoring and Reporting: Monitor accounts for compliance with reporting requirements and data uploads.
• Financial Application of Claims: Evaluate claim refunds and ensure dollars are applied to appropriate claims.
• Internal and External Communication: Communicate claim decisions clearly to internal teams and external clients.

Skills

Medical claims processing

Reinsurance knowledge

Analytical thinking

Project management

Detail-oriented

Communication skills

Problem solving

Tools

Microsoft Office 365

Claims management systems

Job description

Reflect Health is seeking an experienced claims professional to support stop loss claim management and cross-department collaboration. The role emphasizes accuracy in documentation, timely submissions, and strong communication with internal teams and external clients.

The candidate should have experience in medical claims processing, familiarity with reinsurance terms like TLO and Aggregating Specific Deductible, and solid Excel/Office 365 skills.