Job Description
The Medical Claims Analyst is responsible for managing and overseeing medical reinsurance claims in accordance with established treaties. This role involves documenting and reporting reinsurance recoveries, collaborating with intermediaries to ensure compliance with corporate strategy, and reconciling recoveries against financial records. Additionally, the analyst is tasked with reporting special acceptances to reinsurers, tracking discounts, processing reimbursement claims, managing client relationships, and ensuring efficient document management within the medical claims system.
KEY RESPONSIBILITIES
Document and report reinsurance recoveries bi-monthly in alignment with medical reinsurance treaties.
Actively pursue reinsurance recoveries in collaboration with intermediaries to adhere to corporate strategy.
Monthly reporting of special acceptances to reinsurers as outlined in reinsurance treaties.
Reconcile reinsurance recoveries against financial records, taking corrective action for any observed deviations.
Track discounts earned and reported any deviations from set targets.
Attend stakeholder meetings to ensure proper traction of reinsurance claims and report data to various stakeholders.
Process reimbursement claims and ensure timely payments in line with the reimbursement policy.
Manage client and intermediary relationships to uphold service standards.
Process and track ex gratia awards and foreign claims, ensuring compliance with reserving philosophy and claims strategy.
Clean up the medical claims electronic data management system to maintain efficiency.
Organize trainings on document uploads in collaboration with key partners, ensuring compliance with corporate document management policy.
Monitor claims team production through allocation of work, supervision, and general review to ensure quality output.
Proactively manage member benefits and report any unusual trends according to agreed Service Level Agreements (SLA) with suppliers and partners.
Cooperate with internal and external auditors for audits of medical claims practices.
SKILLS & COMPETENCIES
Analytical skills
Decision-making
Good communication and interpersonal skills
Proficiency in all Microsoft applications
Team player
QUALIFICATION
Bachelor’s degree in a relevant field such as Health, Business, Finance, Insurance, or a related discipline.
EXPERIENCE
Previous experience in claims processing or a related field is preferred.
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