Position Purpose: The Reinsurance Analyst analyzes and supports claims activities, as well as utilizing independent discretion to efficiently and accurately monitor the processing of these claims and special high client members for cost containment strategies. This position actively partners with stakeholders to ensure claims are paid timely, edited appropriately and direct care for the best outcome in a cost-effective manner.

Primary Responsibilities:

• Demonstrates leadership utilizing data analysis and analytical skills to drive continuous improvement.
• Ensures overall objectives are done timely and accurately, and that claims are received, processed and paid within contract deadline.
• Researches and identifies complex cases to ensure claims are received in time to meet deadlines, and that claims are paid accurately according to the contract.
• Analyzes documents to determine any required financial adjustments.
• Remains abreast of company and industry changes as well as changes in internal processes and procedures.
• Communicates with internal and external clients to obtain specific information needed for claim processing and mitigation.
• Collaborates with the Accounting team to book corrections and assure ledger accuracy.
• Recommends and implements operational improvements and efficiencies.
• Demonstrates creativity to resolve errors.
• Ability to handle multiple activities, meet deadlines and prioritize workload.
• Excellent customer focus, communication (written and verbal) and interpersonal skills.
• Thrives in an office and virtual work environment.
• Collaborates across functions to support the development of solutions.
• Performs financial statement analysis as part of the monthly close.
• Preparation and analysis of schedules for Annual Statements and audits.
• Supports, develops, and enhances reinsurance reports.
• Communicates with brokers, agents and clients regarding high dollar cost claims and SPEC claimants.

Experience: A High School Diploma or equivalent. Medical terminology and medical claims experience with involvement in reviewing and analyzing claims is beneficial.

Critical Required Skills:

• Must be able to work well independently and in a team atmosphere.
• Maintaining the highest level of confidentiality is critical for this position.
• Identifies and resolves problems in a timely manner and gathers and skillfully analyzes information.
• Demonstrates accuracy and thoroughness and monitors own work to ensure quality.
• Adapts to changes in the work environment, manages competing demands and is able to deal with frequent changes, delays, or unexpected events.
• Ability to manage multiple priorities that change from day to day and week to week in a fast-paced environment.
• Dependability as evidenced by consistently being at work and on time, following instructions, responding to management direction, and soliciting feedback to improve performance.
• Ability to maintain a departmental accuracy standard of 99%.
• Detail oriented.
• Ability to understand system calculations in order to determine if claims are adjudicating accurately.
• Ability to manually process claims in the claims adjudication system if necessary.
• Must understand complicated benefit designs.
• Ability to self-manage, prioritize and meet specific production deadlines.
• Ability to communicate professionally (verbally and in writing) appropriate to the audience.
• Computer experience, including Word, Excel, and Outlook. Must be proficient in MS Excel.
• Accurate 10-key and/or data entry skills.