Senior Insurance Claims Analyst

Seven Corners, Inc. has been a managing general underwriter of international insurance products since 1993. We provide a selection of services to: International Students; Global Corporations; Government Entities; International Agents and Brokers; Foreign Insurance Companies; and Global Benefit Consultants.

Responsibilities:

Responsible for input of foreign and domestic claims as needed.

Responsible for timely claim adjudication within the policy parameters. 

Responsible for requesting and/or processing duplicate payments, overpayments, and payments made in error. 

Responsible for maintaining claim system follow-ups timely. 

Responsible for requesting medical records, office notes, and ER notes. 

Responsible for claim communications, with response as required:

  Internal (other departments)- two working days

  External-  one working day 
Responsible for adherence to quality standards.

-  Claim audit results must meet standards

-  Claim documentation must be maintained within standards.

Responsible for maintaining claim production within standards. 

Responsible for maintaining pending claims listings and current for assigned programs.

Responsible for maintaining compliance with re-insurer reporting requirements, via routine reporting of claims activity to appropriate management personnel or direct report, as required. 

Other duties as assigned.

Supervisory Responsibilities:

May lead to a supervisory role. 

Skills:

Leadership skills a must
Knowledge of how to interpret and apply policy provisions
Excellent written communication skills

Excellent oral sommunication skills

Computer literacy- MS Office experience and proficiency mandatory

Math aptitude

Organization 

Education/ Experience:

College degree required, or related industry experience in management/ supervision
Medical health claim insurance experience mandatory
International medical claim experience a plus 

Knowledge of:

ICD-9 coding 

CPT coding

Claim form types, HCFA and UB-92

Medical/Dental Terminology

PPO Discounting

Subrogation