Reinsurance Coordinator

Lets do great things together!

About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.

Position Summary
Facilitate and coordinates all activities associated with the monitoring advance notification and filing of high dollar claims for reinsurance. Responsible for the development and maintenance of cross-departmental reinsurance policies procedures and guidelines for all lines of business.

Pay Range
$22.88 - $25.74 hourly (depending on experience)
Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page linked below to be considered for this position.

Dental Vision Pharmacy Life & Disability

Required Skills Experience & Education:

1. High school diploma or equivalent. Degree in a health-related field preferred.
2. Two years of medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
3. Knowledge and understanding of Moda Healths contracts and administrative policies affecting claims and customer service.
4. Technical proficiency in Facets Excel and other office applications.
5. Excellent reading oral and written communication skills and ability to interact professionally patiently and courteously.
6. Ability to think critically about systems processes and workflows.
   1. Experience with process improvement training or workflow development preferred.
7. Strong analytical and problem-solving skills.
8. Excellent organizational skills and attention to detail.
9. Demonstrated history of follow through and initiative.
10. Demonstrated strong effective and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.
11. Ability to work well under pressure in a complex and rapidly changing environment.
12. Always maintain confidentiality and project a professional business presence and appearance
13. Demonstrated consistent ability to comply with company rules and policies.
14. Maintain attendance above company standards.
15. Adheres to all other company policies and procedures.

Primary Functions:

1. Identify evaluate track and monitor reports for potential high dollar cases and provide advance notification to the reinsurer as required by the contract.
2. Maintain ongoing and effective communication with Healthcare Services and other departments regarding high dollar cases.
3. Prepare and research all reinsurance claims and submit monthly claims to the reinsurance carrier once a member has exceeded the stop loss for the current year.
   1. Reconcile high dollar claims data totals by extracting data from multiple sources and reporting systems with a high degree of accuracy and within tight time constraints.
4. Own and maintain the High Dollar Report information shared by various departments throughout Moda Health on an on-going basis.
   1. Monitor trigger reports regularly and ensure updates are filtered sorted and reported accurately.
5. Coordinates reporting activities between Healthcare Services staff claims the reinsurance carrier and broker to ensure complete and accurate information is submitted timely and accurately.
6. Develop update and maintain reinsurance documentation and resource materials as needed to ensure information is current and up to date. Owns and maintains Stop loss and Reinsurance reporting UPM and other training resources.
7. Participates in and may facilitate work groups and committees.
8. On-going communication with staff from Corporate Accounting and Corporate Data providing accurate information on claims submitted for reinsurance and the claim dollars recovered.
9. Research and gather factual reinsurance claims issues and identify complex issues which should be referred to Supervisor and/or Manager.
10. Assist with drafting of correspondence regarding reinsurance coverage and claims related issues
11. Assist the assigned team with audit duties and responsibilities as determined by the Supervisor and/or Manager as time permits.
12. Perform other duties as assigned

Working Conditions &Contact with Others

• Office environment with extensive close PC and keyboard work constant sitting and standing for prolonged periods and phone work. Must be able to navigate multiple screens. Overtime may be required. Work in excess of 37.5 hours per week including evenings and occasional weekends to meet business need.
• Internally with Accounting Membership Accounting Claims Corporate Healthcare Services Sales and Account Services Professional Relations and Underwriting. Externally with Reinsurance Carriers Brokers Medical Carriers Case Management Organizations and other related vendors.
  

Together we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.

For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our email.