Claims Analyst

HRMP, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We provide a variety of services and solutions within the insurance market such as stop-loss program administration, group life and medical conversions, auditing services, back office or run-out administration, quota share and excess medical reinsurance.

HRMP, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We provide a variety of services and solutions within the insurance market such as stop-loss program administration, group life and medical conversions, auditing services, back office or run-out administration, quota share and excess medical reinsurance.

The Claims Analyst will work a hybrid schedule reporting to our Jencap office in Danvers, MA. We are also accepting remote applicants depending upon location.

Responsibilities:

• Coordinates directly with Senior Claims Analyst, Manager, and Managing Director.
• Guides claims admin staff as necessary.
• Coordinates closely with Policy Issuance and Accounting departments.
• Processes/reviews 50% notifications
• Establishes proof of loss by reviewing medical documentation presented, requesting additional information from sources such as administrator, broker, hospital, physician, etc.
• Adjudicates claims in medical stop loss system (ESL) and or (UGAN) approving, denying based on compliance with SPD and Stop loss policy.
• Applies Anti-Fraud Guidelines as appropriate.
• Claims authority determined based upon experience and client requirements.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and California Fair Claims Settlement Practices,
• Knowledge of CPT/HCPCS, Revenue and ICD9 to ICD10 coding procedures and guidelines

Requirements:

• Minimum of two (2) plus years medical stop loss claims processing
• Flexibility to handle multiple priorities while maintaining high level of professionalism. Must be able to work well independently or in a team environment.
• Proficiency using Microsoft office products.
• Working knowledge of David Young (ESL System) and/or Kevin Ugan system.