Reinsurance Coordinator

at  Moda Health

REQUIRED SKILLS, EXPERIENCE & EDUCATION:

• High school diploma or equivalent. Degree in a health-related field preferred.
• Two years of medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
• Knowledge and understanding of Moda Health’s contracts and administrative policies affecting claims and customer service.
• Technical proficiency in Facets, Excel, and other office applications.
• Excellent reading, oral, and written communication skills, and ability to interact professionally, patiently, and courteously.
• Ability to think critically about systems, processes, and workflows.
• Experience with process improvement, training, or workflow development preferred.
• Strong analytical and problem-solving skills.
• Excellent organizational skills and attention to detail.
• Demonstrated history of follow through and initiative.
• Demonstrated strong, effective, and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.
• Ability to work well under pressure in a complex and rapidly changing environment.
• Always maintain confidentiality and project a professional business presence and appearance
• Demonstrated consistent ability to comply with company rules and policies.
• Maintain attendance above company standards.
• Adheres to all other company policies and procedures.

Primary Functions:

• Identify, evaluate, track and monitor reports for potential high dollar cases and provide advance notification to the reinsurer as required by the contract.
• Maintain ongoing and effective communication with Healthcare Services and other departments regarding high dollar cases.
• Prepare and research all reinsurance claims and submit monthly claims to the reinsurance carrier once a member has exceeded the stop loss for the current year.
• Reconcile high dollar claims data totals by extracting data from multiple sources and reporting systems, with a high degree of accuracy, and within tight time constraints.
• Own and maintain the High Dollar Report information shared by various departments throughout Moda Health, on an on-going basis.
• Monitor trigger reports regularly and ensure updates are filtered, sorted, and reported accurately.
• Coordinates reporting activities between Healthcare Services staff, claims, the reinsurance carrier, and broker to ensure complete and accurate information is submitted timely and accurately.
• Develop, update and maintain reinsurance documentation and resource materials as needed to ensure information is current and up to date. Owns and maintains Stop loss and Reinsurance reporting UPM and other training resources.
• Participates in and may facilitate work groups and committees.
• On-going communication with staff from Corporate, Accounting and Corporate Data, providing accurate information on claims submitted for reinsurance and the claim dollars recovered.
• Research and gather factual reinsurance claims issues and identify complex issues which should be referred to Supervisor and/or Manager.
• Assist with drafting of correspondence regarding reinsurance coverage and claims related issues,
• Assist the assigned team with audit duties and responsibilities as determined by the Supervisor and/or Manager as time permits.
• Perform other duties as assigned

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard work, constant sitting and standing for prolonged periods, and phone work. Must be able to navigate multiple screens. Overtime may be required. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.
• Internally with Accounting, Membership Accounting, Claims, Corporate, Healthcare Services, Sales and Account Services, Professional Relations, and Underwriting. Externally with Reinsurance Carriers, Brokers, Medical Carriers, Case Management Organizations, and other related vendors.

Please refer the Job description for details