Claims Specialist, Accident & Health

We are looking for a Claims Specialist who will be responsible for reviewing Accident & Health (A&H) claims, interpreting, and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination.

This role is responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This 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 relative to the reimbursement or denial of a claim.

In this position you are accountable to develop, coordinate, and implement a plan of action for each claim accepted to ensure it is effectively managed and all cost containment initiatives are implemented in conjunction with the clinical resources.

About the team

This position will be a part of the North America Corporate Solutions A&H medical stop loss claims team.  We are a highly engaged group of individuals!  We work independently yet collaborate and support each other in a highly effective way.  We take great pride in our work efforts and product.  Our team values integrity and a strong work ethic. We encourage and mentor each other while we move the team forward for the success of each member and the business. 

About You

You thrive in an energizing, fast-paced environment with flexibility to handle multiple priorities while maintaining a high level of professionalism.  You bring strong verbal and written communication skills and are adept at collaboration and teamwork.  Your excellent analytical skills make you naturally detail oriented.

Additional requirements include:

• Some College or Certifications in a related field preferred or equivalent experience
• 1-3 years of first dollar medical claims processing or similar experience
• Knowledge of common medical terminology, diseases and their related risks
• Basic knowledge of Stop Loss Industry a plus
• Overall knowledge of healthcare industry
• Experience with Excel and Microsoft Office Products Essential

The estimated base salary range for this position is $84,000 to $140,000.  The specific salary offered for this or any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget.  At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation.