Reinsurance Administrator (Stop Loss) - LH

About the role

The Reinsurance Administrator at Luminare Health is responsible for accurately and timely filing of excess risk medical claims. This role involves working collaboratively with excess risk companies, answering questions, resolving problems on filings, handling initial appeals, and coordinating all reporting provided by the excess risk companies.

Responsibilities

• Identify and prepare stop loss claims submissions to obtain client reimbursement over their specific deductible amount.
• Communicate with Client Management, Claims, Finance, and other impacted departments.
• Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount.
• Review and process all returned checks resulting from stop loss reimbursements.
• Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client.
• Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end.

Requirements

• A High School Diploma or GED equivalent.
• 1 – 2 years of medical claims experience, including hands-on experience with stop loss (excess risk) claims processing and submissions.
• Proficient experience with MS Word, Excel, and Outlook.
• Previous knowledge of employee benefits, third party benefit administration, or reinsurance.
• A self-directed individual that works well with minimal supervision.
• Flexible; open to change and finding better ways to operate efficiently.
• Excellent interpersonal and communication skills with all levels of an organization.
• The ability to effectively present information and respond to questions.
• Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency.
• Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data.

Qualifications

• A High School Diploma or GED equivalent.
• 1 – 2 years of medical claims experience, including hands-on experience with stop loss (excess risk) claims processing and submissions.
• Proficient experience with MS Word, Excel, and Outlook.
• Previous knowledge of employee benefits, third party benefit administration, or reinsurance.
• A self-directed individual that works well with minimal supervision.
• Flexible; open to change and finding better ways to operate efficiently.
• Excellent interpersonal and communication skills with all levels of an organization.
• The ability to effectively present information and respond to questions.
• Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency.
• Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data.

Skills

• High level of detail.
• Ability to work with time-sensitive deadlines.

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.

Pay

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan. Min To Max Range: $18.07 - $33.92 Exact compensation may vary based on skills, experience, and location.

Schedule

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.