Windsor, CT, US Kansas City, MO, US
Claims Expert, Accident & Health (Hybrid Work Model)
About the Role
This Claims Expert position is responsible for the processing of all levels of claims from low touch to complex claims, with the vast majority being complex claims, including responsibility for customer service and the financial risk associated with an assigned block of Stop Loss claims.
Additional responsibilities include:
- Reviewing claims, interpreting, and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination
- Handling voids, refunds and other complex tasks
- Developing, coordinating, and implementing a plan of action for each claim accepted, ensuring it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources
- Training and mentoring junior talent
Claims review in this role requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide relative to the reimbursement or denial of a claim.
About the Team
North America Corporate Solutions A&H Claims team is responsible for the review, adjudication and maintenance of claim files to include, reporting and monitoring the related action items. We perform deep analysis of industry trends that impact claim exposure. We collaborate with and provide our risk management partners with appropriate information. We are a cohesive diverse team of 20+ employees located in KC and Windsor as well several remote employees. We take great pride in our work and the reputation we have built. We look forward to adding to our team!
About You
You thrive working in a fast -paced environment! Your flexibility enables you to handle multiple priorities while maintaining a high level of professionalism. Your strong verbal and written communication skills lead your success in customer service and cross-functional collaboration.
Additional requirements include:
- Some College or Certifications in a related field preferred or equivalent experience
- 5+ years of first dollar medical claims processing and 10+ years Stop Loss experience
- Knowledge of common medical terminology, diseases and their related risks
- Heavily detail-oriented with very strong analytical skills
- Overall knowledge of healthcare industry
- Experience with Excel and Microsoft Office Products Essential as well as Data Analytics.
About Swiss Re Corporate Solutions
Swiss Re is one of the world’s leading providers of reinsurance, insurance and other forms of insurance-based risk transfer. We anticipate and manage risks, from natural catastrophes and climate change to cybercrime.
Swiss Re Corporate Solutions is the commercial insurance arm of the Swiss Re Group. We offer innovative insurance solutions to large and midsized multinational corporations from our approximately 50 locations worldwide. We help clients mitigate their risk exposure, whilst our industry-leading claims service provides them with additional peace of mind.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. Swiss Re Corporate Solutions embraces a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
Reference Code: 129560
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Claims, Risk Management, Insurance, Finance