Reinsurance Claim Analyst

Job not on LinkedIn

🔥 2 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $60k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔒 Insurance

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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S&S Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1994

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

S&S Health is a modern health administration provider dedicated to offering affordable healthcare solutions for employers and their employees. By focusing on cost management, S&S Health helps businesses reduce healthcare expenses while maintaining high-quality care. With end-to-end support, they provide tools and resources to ensure that employees have access to the right medical care at competitive prices, ultimately aiming to improve both health outcomes and financial wellbeing.

📋 Description

• Review stop loss policies and ensure accurate setup within claims management systems • Verify policy terms and conditions, including TLO (Specific Stop Loss) and Aggregating Specific Deductible • Collect and verify documentation for stop loss claims, including eligibility documentation, medical records, subrogation details, and cost containment reports • Assist with timely and accurate filing of routine, specific, aggregate, and complex stop loss claims • Collaborate with Operations, Finance, and Sales on claim status and claims-process communication • Monitor accounts for reporting compliance • Track premium remittances and ensure timely, accurate system data uploads • Evaluate claim refunds and apply dollars properly to respective claim filings • Communicate claim decisions clearly to internal teams and external clients based on policy guidelines and group plan documentation

🎯 Requirements

• Experience in medical claims processing, preferably in reinsurance • Familiarity with reinsurance policies and terms such as TLO (Specific Stop Loss) and Aggregating Specific Deductible • Strong critical thinking skills and ability to evaluate and manage complex data and claims • Proven ability to manage multiple tasks, prioritize responsibilities, and work independently in a fast-paced environment • Intermediate proficiency with Microsoft Office 365, including Excel, Visio, and Word • Experience with claims management systems is a plus • Highly organized with keen attention to detail and accuracy • Excellent verbal and written communication skills • Strong analytical and problem-solving skills • Must complete a comprehensive background check and drug testing as part of the hiring process