Reinsurance Administrator (Stop Loss) - LH

Job description

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success. We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable. 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 supervision Flexible; open to change and finding better ways to operate efficiently Excellent interpersonal and communication skills with all levels of an organization Ability to effectively present information and respond to questions Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii. 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 supervision Flexible; open to change and finding better ways to operate efficiently Excellent interpersonal and communication skills with all levels of an organization Ability to effectively present information and respond to questions Strong time management skills; including the ability to organize and coordinate multiple tasks, communicate information in a timely fashion and with appropriate sense of urgency Demonstrated problem-solving and claims investigation skills and the ability to analyze and interpret claims data Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii . Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! EEO Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Pay Transparency Statement: At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Min to Max Range: $18.07 - $33.92 Exact compensation may vary based on skills, experience, and location.