Claims Analyst
Jencap - Danvers, Massachusetts, us, 01923Work at Jencap
Overview
- Apply
Overview
P
, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We
provid
e
a variety of services
and solutions
within the insurance market such as stop-loss program administration, group life
and medical
conversion
s
, auditing
services
,
back office or
run-out administration
,
quota share and excess medical reinsurance.
HRM
P
, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We
provid
e
a variety of services
and solutions
within the insurance market such as stop-loss program administration, group life
and medical
conversion
s
, auditing
services
,
back office or
run-out administration
,
quota share and excess medical reinsurance.
The Claims Analyst
will work a hybrid schedule reporting to our Jencap office in Danvers, MA. We are also accepting
remote
applicants depending upon location.
Responsibilities:
Coordinates directly with Senior Claims Analyst, Manager, and Managing Director.
Guides claims admin staff as necessary.
Coordinates closely with Policy Issuance and Accounting departments.
Processes/reviews 50% notifications
Establishes proof of loss by reviewing medical documentation presented, requesting additional information from sources such as administrator, broker, hospital, physician, etc.
Adjudicates claims in medical stop loss system (ESL) and or (UGAN) approving, denying based on compliance with SPD and Stop loss policy.
Applies Anti-Fraud Guidelines as appropriate.
Claims authority determined based upon experience and client requirements.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and California Fair Claims Settlement Practices,
Knowledge of CPT/HCPCS, Revenue and ICD9 to ICD10 coding procedures and guidelines
Requirements:
Minimum of two (2) plus years medical stop loss claims processing
Flexibility to handle multiple priorities while maintaining high level of professionalism. Must be able to work well independently or in a team environment.
Proficiency using Microsoft office products.
Working knowledge of David Young (ESL System) and/or Kevin Ugan system.
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