Reinsurance Analyst

🔥 1 minute ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔒 Insurance

🚫👨‍🎓 No degree required

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Blue Cross Blue Shield of Arizona

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Blue Cross Blue Shield of Arizona is a health insurance provider offering a variety of health plans tailored to individuals, families, employers, and Medicare recipients. With a commitment to improving healthcare access and community health, AZ Blue provides self-insured and ACA-compliant health plans, including Medicare Advantage and Medicaid options. The organization focuses on connecting members with care through its extensive network, aiming for better health outcomes and community support.

📋 Description

• Assist with day-to-day activities for the reinsurance department • Research and review claims to recover eligible stop-loss reimbursement • Identify and manage Transplant Reinsurance claims and cases • Coordinate with Medical Services’ transplant coordinator to create and maintain transplant cases and stages with AHCCCS • Review transplant logs and monitor case stages and component payments • Enter and maintain transplant reinsurance cases in PMMIS • Track and balance encounters against PMMIS screen RI113 before component submission • Identify and manage Catastrophic Reinsurance claims and cases • Submit annual Catastrophic Reinsurance renewal letters to AHCCCS Medical Management within 30 days of each contract year • Coordinate with the Claims department to ensure proper processing of Medicaid reinsurance claims • Ensure reinsurance claims and CRNs are encountered and associated according to applicable rates • Adhere to timely filing limits • Review AHCCCS reinsurance reports monthly • Work with Accounting and Data Warehouse to maintain accurate reinsurance reconciliation • Maintain current knowledge of AHCCCS reinsurance manuals, procedures, and requirements • Review high-dollar claims reports to ensure all reinsurance is captured • Provide motivation, encouragement, instruction, and role-model support to others or subordinates depending on level • Perform other duties as assigned

🎯 Requirements

• 2 years of experience in health plan reinsurance, claims unit, or AHCCCS administration (Level 1) • 3 years of experience in health plan reinsurance, claims unit, or AHCCCS administration (Level 2) • High School Diploma or GED • Knowledge of healthcare and system design, including Oracle • Knowledge of accounts payable and financial reporting • Analytical research and reporting abilities • Knowledge of reinsurance recovery, recoupments, refund posting, and COB verification • Knowledge of Medicaid and Medicare coverage and regulations • Understanding of claims processing • Knowledge of AHCCCS guidelines and reinsurance requirements • General knowledge of Excel, Word, Beginner SQL, MedMc, and QNXT • Ability to communicate effectively orally and in writing • Ability to establish and maintain effective working relationships • Ability to perform duties of lower levels for progressive levels • Must work a full-time schedule of at least 40 hours per week • Bachelor’s degree in accounting, business, or related field is preferred

🏖️ Benefits

• Remote work within the state of Arizona • Full-time employment (at least 40 hours per week) • Flexible work location under AZ Blue’s Workability workforce strategy • Health insurance products and services offered by the employer