Reinsurance Claim Analyst

S&S Health

. Review stop loss policies and ensure accurate setup within claims management systems .

Posted 10/14/2026full-timeRemote • Ohio • United StatesMid-LevelSenior💰 $60,000 - $80,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing and reinsurance policies, with a strong focus on accuracy and compliance in claims management. Proficient in evaluating complex data and effectively communicating claim decisions to stakeholders.

Highest-signal resume keywords

Medical Claims ProcessingReinsurance PoliciesClaims Management SystemsMicrosoft Office 365Critical Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingData EvaluationPolicy VerificationDocumentation CollectionClaims FilingCompliance MonitoringPremium TrackingClaim Refund EvaluationAttention to DetailProblem-Solving

Soft Skills

Organizational SkillsCommunication SkillsAnalytical SkillsTime ManagementIndependence

Tools & Technologies

Microsoft ExcelMicrosoft VisioMicrosoft Word

Industry Keywords

Stop Loss PoliciesSpecific Stop LossAggregating Specific DeductibleCost ContainmentSubrogation

About the role

Key responsibilities & impact

Review stop loss policies and ensure accurate setup within claims management systems
Verify policy terms and conditions, including TLO (Specific Stop Loss) and Aggregating Specific Deductible
Collect and verify documentation for stop loss claims, including eligibility documentation, medical records, subrogation details, and cost containment reports
Assist with timely and accurate filing of routine, specific, aggregate, and complex stop loss claims
Collaborate with Operations, Finance, and Sales on claim status and claims-process communication
Monitor accounts for reporting compliance
Track premium remittances and ensure timely, accurate system data uploads
Evaluate claim refunds and apply dollars properly to respective claim filings
Communicate claim decisions clearly to internal teams and external clients based on policy guidelines and group plan documentation

Requirements

What you’ll need

Experience in medical claims processing, preferably in reinsurance
Familiarity with reinsurance policies and terms such as TLO (Specific Stop Loss) and Aggregating Specific Deductible
Strong critical thinking skills and ability to evaluate and manage complex data and claims
Proven ability to manage multiple tasks, prioritize responsibilities, and work independently in a fast-paced environment
Intermediate proficiency with Microsoft Office 365, including Excel, Visio, and Word
Experience with claims management systems is a plus
Highly organized with keen attention to detail and accuracy
Excellent verbal and written communication skills
Strong analytical and problem-solving skills
Must complete a comprehensive background check and drug testing as part of the hiring process