Claims Administrator

About Acrisure:

Acrisure is a global Fintech leader that combines the best of humans and high tech to offer multiple financial products and services to millions of businesses and individual clients. We connect clients to solutions that help them protect and grow what matters, including Insurance, Reinsurance, Cyber Services, Mortgage Origination and more.

Acrisure employs over 17,000 entrepreneurial colleagues in 21 countries and have grown from $38 million to $4.3 billion in revenue in just over ten years. Our culture is defined by our entrepreneurial spirit and all that comes with it: innovation, client centricity and an indomitable will to win.

Here at Breckpoint, we have a one-of-a-kind program that allows any size employer to self-insure their health benefits. For over 15 years the Breckpoint team has specialized in consulting, forming, and managing alternative risk programs spanning self-insured groups, captives, and traditional self-funding arrangements. Our expertise extends to employer benefits, with over $30M in premium within our major medical program. Leveraging diverse strategies, we maximize the benefit of self-funding while integrating sustainable cost containment solutions. Currently we seek an Underwriting Analyst to contribute to the maintenance and expansion of our program.

Job Summary:
The Claims/Policy Administrator reviews reports, notices and processes and updates the system accordingly. This position will also report reinsurance in both potential and actual losses.

Here at Breckpoint, we have a one-of-a-kind program that allows any size employer to self-insure their health benefits. For over 15 years the Breckpoint team has specialized in consulting, forming, and managing alternative risk programs spanning self-insured groups, captives, and traditional self-funding arrangements. Our expertise extends to employer benefits, with over $30M in premium within our major medical program. Leveraging diverse strategies, we maximize the benefit of self-funding while integrating sustainable cost containment solutions. Currently we seek an Underwriting Analyst to contribute to the maintenance and expansion of our program.

Responsibilities:

• Track, log in the underwriting system, and evaluate monthly aggregate reporting from partner channels, brokers, and third-party administrators.

• Track, log in the unwriting system, and evaluate monthly risk reporting from partner channels, brokers, and third-party administrators.

• Track, log in the underwriting system, and audit trigger notices and potential large claim notices for completeness and ongoing risk potential.

• Track, log, and audit specific claim reimbursement requests in the underwriting system. Including eligibility, facility and provider claims payments, subrogation/accident information.

• Follow up with partner channels, brokers, and third-party administrators for additional information to assess ongoing risk potential.

• Complete all required reporting to management and committee members.

• Present all findings to management committee.

• Work directly with finance on funding reimbursement requests.

• Assist team members across all aspects of the underwriting and sales and administration process.

• Understand the coverage afforded by the forms and can explain the exposure to loss assumed and restricted by the insuring agreements, exclusions, and conditions of coverage.

• Audit sold case documents for accuracy and proper signatures.

• Audit and track required final reporting on all sold cases.

• Create and track insurance applications, riders, and agreement with the ability to complete policy issuance procedures.

Skills:

• Full working knowledge of all carrier policy requirements and claims auditing practices.

• Full working knowledge of major medical benefit plans.

• Demonstrate a continuous improvement mindset.

• Good communication skills.

• Good Computer Skills, Strong Knowledge of Microsoft Office (Microsoft Word, Microsoft Excel).

• Manages desk responsibilities, including meeting quoting deadlines, conducting roundtables, obtaining appropriate sign offs for authority, getting underwriting notes completed fully and timely.

• Maintain time-service, quality, and production goals for assigned work.

Education:

• Bachelor’s degree preferred

• 3 years medical claims or stop loss claims auditing experience preferred

Work Environment

This job operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers and filing cabinets.

Position Type/Expected Hours of Work

This is a full-time position. Hours of work are Monday through Friday for a total of 40 hours per week.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

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Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status.  California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant.
 

To Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisure’s property, and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisure’s Human Resources Talent Department.