[Hiring] Reinsurance Analyst @Blue Cross Blue Shield of Arizona

Role Description

The Recoveries Analyst’s primary line of business is Medicaid. The primary purpose of the Analyst is to research and review all claims and use best practices in the recovery of any eligible stop-loss reimbursement. (Level 1)

The Recoveries Department Sr serves as the department lead for both the Medicare and Medicaid reinsurance lines of business. Provides support to the Reinsurance manager by taking the lead in all managerial functions, such as hosting meetings, reporting data, and adding unification within all areas of the company. The primary purpose of the Sr is to provide leadership and educate best practices in the recovery of any eligible stop-loss reimbursement. (Level 2)

Qualifications

• 2 years of experience in health plan reinsurance or claims unit or AHCCCS administration (Level 1)
• 3 years of experience in health plan reinsurance or claims unit or AHCCCS administration (Level 2)
• High School Diploma or GED
• Bachelor’s degree in accounting, business or related field of study (Preferred)

Requirements

• Assist in the day-to-day activities for the reinsurance department.
• Identify and manage Transplant Reinsurance claims/cases in a timely and efficient manner by:
  • In coordination with Medical Service’s transplant coordinator to create and maintain transplant cases and stages with AHCCCS.
  • Review transplant log to ensure all cases are created and monitor stage and component payment.
  • Transplant reinsurance cases are entered and maintained in PMMIS and encounters are tracked and balanced against PMMIS screen RI113 to ensure proper balancing prior to component submission.
• Identify and manage Catastrophic Reinsurance claims/cases in a timely and efficient manner by:
  • Submit Annual Catastrophic reinsurance renewal letters to AHCCCS Medical Management within 30 days of the beginning of each contract year to ensure timely creation of Catastrophic Reinsurance cases.
  • Coordinate with Claims department to ensure proper processing of all Medicaid reinsurance claims.
  • Ensure all reinsurance claims/CRN are encountered and associating according to AHCCCS or Medicaid Business Segment’s rates.
  • Adhere to AHCCCS timely filing limits to ensure proper reimbursement.
  • Review AHCCCS reinsurance reports (Case Summary, Remittance Advice, Case Initiation and Case Reconciliation) monthly to ensure proper reinsurance reimbursement.
  • Work directly with Accounting and Data Warehouse to maintain accurate Medicaid reinsurance reconciliation.
  • Maintain current working knowledge of AHCCCS reinsurance manual, procedures, and requirements.
  • Review high dollar claims report to ensure all reinsurance is captured.
• Provide motivation, encouragement, and be a role model to others internal and external of the company.
• Perform all other duties as assigned.
• The position requires a full-time work schedule, defined as working at least 40 hours per week, plus any additional hours as requested or needed to meet business requirements.

Benefits

• Flexible work options (hybrid, onsite, remote).
• Health insurance products and services.

Company Description

AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses, as well as providing information and tools to help individuals make better health decisions.