Stealth Partner Group
The Claims Analyst is responsible for learning Stealth’s business model and understanding the products we support. Under the direction of the Claims Manager and Lead Claims Auditor, the Claims Analyst will learn and employ all processes necessary to provide outstanding medical/rx claims management services on behalf our self-funded clients who contract with Third-Party Administrators.
KEY RESPONSIBILITIES
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Learn all internal responsibilities pertaining to the claim’s management of client accounts with Third Party Claim Administrators under the direction of assigned Claims Manager and Lead
- Effectively correspond with carriers, administrators, clients and brokers in an accurate and timely manner using approved form letters and emails, copying Claims Lead on all correspondence
- Work under the direction of the Claims Lead on any correspondence requiring personalization
- Management of monthly claim reports required for administration of assigned book of business, including forwarding to appropriate carrier and following-up on reports not received
- Review submitted reimbursement requests for completeness
- Request information missing, if any, for submitted reimbursement requests
- Obtain approval from Claims Lead on eligibility documentation which notates time-off exceeding twelve (12) weeks prior to submitting claim reimbursement request
- Record and submit reimbursement requests to appropriate carrier up to authorized dollar authority of $250,000 and obtain approval from Claims Lead on amounts over dollar limit authority prior to claim submission
- Track all reimbursement requests and proactively follow up on outstanding monies due
- Review and issue reimbursements, and notification of reimbursements to designated contacts in an accurate and timely manner
- Maintain internal claim tracking logs
- Under the Claim Leads direction, manage the settlement of all reimbursement requests at the end of the plan year in order to close the client’s account
- Other duties and projects as assigned
QUALIFICATIONS AND REQUIREMENTS
- Eagerness to learn Stealth’s business model and understand the products we work with is a necessity
- College degree or equivalent work experience strongly preferred
- Proficiency with Microsoft office products including Word, Excel, Outlook and PowerPoint
- Ability to maintain strict confidentiality
- Ability to multi-task and adjust to changing priorities in a fast-paced environment
- Proven ability to effectively manage time, prioritize workload and meet deadlines
- Strong teamwork skills; ability to work cooperatively and jointly with various staff members
- Strong organizational and multi-tasking skills
- Ability to effectively communicate, both written and verbally, with internal and external parties
- Sense of urgency and attention to detail are necessities
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Work Environment and Physical Demands
This job operates in an office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
EEO/AAP Policy Statement
Stealth Partner Group provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.
Monday-Friday, flexible between hours 7A-6:30P
To apply for this job please visit www.amwins.com.