Share this Job
Location: 

Windsor, CT, US

 

Claims Specialist 

About Swiss Re

Swiss Re Corporate Solutions provides risk transfer solutions to large and mid-sized corporations around the world. Its innovative, highly customized products and standard insurance covers help to make businesses more resilient, while its industry-leading claims service provides additional peace of mind. Swiss Re Corporate Solutions serves clients from over 50 offices worldwide and is backed by the financial strength of the Swiss Re Group.

 

About the Team:

 

Do you like working with different cultures? Are you open minded and able to focus on detail?

This is a rare opportunity to join our unit within an established company, combining the dynamic spirit of the team with the backing of Swiss Re's strong organization.  We are 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.

 

About the Role:

This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. You are 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 each claim to decide on reimbursement or denial of a claim. You will have a claim approval limit of $50,000 and approve all claims up to that amount based on department guidelines and will submit larger dollar claims to a higher level authority as stated in the department guidelines for approval. You are accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources.

 

About You:

Bachelor's degree in a related field preferred or equivalent experience

  • Knowledge of common medical terminology, diseases and their related risks
  • Do you possess a basic knowledge of Stop Loss Industry
  • Demonstrated success in negotiation, persuasion, and solutions-based claim paying
  • Ability to work in an energizing environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
  • Overall knowledge of healthcare industry
  • Strong oral and written communications skills
  • Strong analytical skills and the ability to pay attention to details
  • Do you have Excellent Excel and Word Skills?

 

 

 

The Company is an equal opportunity employer. It is the practice of the Company to recruit, hire and promote without regard to race, religion, color, national origin, sex, disability, age, pregnancy, sexual orientations, marital status, military status, or any other characteristic protected by law. Decisions on employment are solely based on an individual's qualifications for the position being filled.

During the recruitment process, reasonable accommodations for disabilities are available upon request. If contacted for an interview, please inform the Recruiter/HR Professional of the accommodation needed.

 

Keywords: claims, A&H 

 


Nearest Major Market: Hartford

Find similar jobs: