Job Description
At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary The Reinsurance Administrator is responsible for accurate and timely filing of excess risk medical claims. In this role, you will work collaboratively with excess risk companies to answer questions, resolve problems on filings, and handle initial appeals for reinsurance. The Reinsurance Administrator will also be responsible for coordinating all reporting that is supplied by the excess risk companies and distributing as required. This is a role that requires a high level of detail and the ability to work with time sensitive deadlines. Identify and prepare stop loss claims submissions to obtain client reimbursement over their specific deductible amount. Communicate with Client Management, Claims, Finance and other impacted departments. Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount. Review and process all returned checks resulting from stop loss reimbursements. Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client. Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end. Other duties as needed/assigned. Required Job Qualifications: High School Diploma or GED equivalent 1 – 2 years of medical claims experience, including hands-on experience with stop loss (excess risk) claims processing and submissions Proficient experience with MS Word, Excel and Outlook Previous knowledge of employee benefits, third party benefit administration or reinsurance Self-directed individual that works well with minimal
