Danvers, MA 01923
Full-time
The Senior Claims Examiner is responsible for the following duties within a dedicated unit serving the HMO Reinsurance/Provider Excess, Stop Loss and Reinsurance Claims needs of our clients.
- Extensive knowledge and experience adjudicating accident and health claims for traditional medical, specific and aggregate excess, HMO reinsurance or provider excess claims.
- Audit and review of managed care and provider excess contracts, provider agreements, risk-sharing documents to quantify and verify claims accordingly.
- Audit and review of specific and aggregate excess claims, consulting with clients and per review within the unit.
- Occasional travel is possible.
Requirements:
- A minimum of 5+ years claims experience
- Experience with first dollar medical claims, audit, and medical terminology is preferred.
- Knowledge and experience with self-insured plans and stop loss coverage is required.
- Excellent written, verbal, and analytical skills are required.
- Strong computer skills are necessary for use of Microsoft Word, Excel, Access.
Full benefits package offered. Salary is commensurate with experience.
About NiiS:
Northshore is a consulting and insurance services organization that specializes in audit, claims management and subrogation services. Our clients include organizations in the accident and health, property and casualty insurance industries, employers, governmental entities, and other risk assumption vehicles.
Northshore provides services worldwide and is headquartered in Danvers, Massachusetts with offices throughout the United States.
