Financial Claims Associate
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Financial Claims Associate analyzing health-plan claims expenses, invoicing, and stop-loss coverage for Blue Cross NC. Supporting forecasts, reconciliations, audits, and employer-group reporting.
Responsibilities:
- Perform financial claims expense invoicing, reporting, analysis, reimbursement determination, and forecasting
- Prepare financial claims expense invoices, weekly statements, forecasts, schedules, and month-end close materials
- Analyze and present historical and forecasted claims expense and stop loss coverage information
- Prepare loss coverage financials for employer groups and stop loss vendors
- Review employer group subgroup expenditures for compliance with Administrative Agreements
- Prepare reports and variance analyses for employer groups, stop loss vendors, Sales, Underwriting, and other audiences
- Verify manual transaction fees and contractual adjustments
- Prepare estimates and adjustments for new and existing business
- Reconcile statements of account and assist with monthly run-out and final close-out activities
- Compile data for internal and external audits
- Process claims-related client transactions, including claim holds, run-out administrative fees, and employer group settlements
- Determine stop loss coverage eligibility for claims based on contract terms
- Research utilization, provider information, medical reviews, leave-of-absence language, COBRA benefits, and plan documentation
- Perform quality reviews of operational inquiries to ensure accurate information and expected service levels
Requirements:
- Bachelor's degree or advanced degree (where required), or 3+ years of experience in a related field in lieu of degree
- 0-2 years of experience in a related field
- Ability to perform financial claims expense invoicing, reporting, analysis, reimbursement determination, and forecasting
- Ability to prepare financial claims expense reports, weekly invoices, statements, forecasts, and reconciliations
- Ability to research claims, plan policies, products, rates, membership, enrollment, underwriting, direct sales, contracts, and program engagement
- Ability to analyze stop loss coverage, high-dollar claims, claimants' performance, trends, and contractual adjustments
- Ability to determine stop loss benefit eligibility based on contract terms
- Ability to support audits, variance analysis, quality reviews, and client transactions
Benefits:
- Work-life balance, flexibility, and autonomy
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continued education
- 401(k) match including an annual company contribution
- Paid Time Off (PTO)
- Annual Incentive Bonus
- Remote work with a few in-office visits each year for meaningful moments
Similar Jobs
Senior Environmental, Construction Defect Claims Specialist
Senior claims specialist managing complex environmental, toxic tort, and construction defect claims for Amerisure, a commercial property and casualty insurer. Evaluating coverage, liability, damages, reserves, and settlements across jurisdictions.
Senior Claims Specialist, Commercial Casualty
Senior commercial casualty claims specialist resolving personal and commercial injury claims for Mobilitas, a mobility-sector insurer. Handling nationwide coverage, liability, investigation, negotiation and subrogation.
Complex Casualty Claims Specialist
Complex casualty claims specialist managing severe casualty litigation, investigations, reserves and settlements for EMC. Providing technical claims expertise while collaborating with counsel, underwriting and recovery teams nationwide.
Marine Claims Adjuster
Remote Marine Claims Adjuster handling inland marine property and liability claims. Investigating, evaluating, negotiating, and resolving commercial and personal insurance losses.
Marine Claims Adjuster
Marine Claims Adjuster investigating and resolving inland marine property and liability claims for an insurance team. Handling commercial coverages, negotiations, and exposures up to $25,000.
Claims Processor I
Claims Processor I researching, correcting, and entering health insurance claims for Blue Cross and Blue Shield of Louisiana. Ensuring accurate adjudication, complete documentation, and timely processing.
Property Claims Representative
Property Claims Representative investigating and resolving property claims for Preferred Mutual Insurance. Evaluating coverage, liability, damages, reserves, and subrogation opportunities.
Commercial Auto Claims Representative – Pre-Suit Bodily Injury
Commercial auto claims adjuster handling pre-suit bodily injury investigations, coverage analysis, and injury valuation. Resolving claims remotely for Berkshire Hathaway’s biBerk commercial insurance business.
Senior Claims Representative
Senior Claims Representative managing high-exposure workers’ compensation claims for MEM Insurance. Leading investigations, settlements, compliance, reporting, and adjuster development.
Claims Coordinator
Claims Coordinator processing healthcare claims for Machinify’s AI-powered health plan platform. Reviewing documents, entering claim data, routing files, and ensuring HIPAA-compliant processing.
Auto Commercial Claims Adjuster
Commercial claims adjuster managing transportation physical damage claims for Reserv’s AI-driven insurtech platform. Investigating losses, negotiating settlements, and coordinating repairs, recovery, and total-loss outcomes.
Senior Claims Specialist
Senior Claims Specialist managing complex workers’ compensation claims for CorVel, a national risk-management solutions provider. Investigating claims, managing litigation and recoveries, and negotiating outcomes remotely in California.
Executive Claims Specialist, Bodily Injury
Executive Claims Specialist overseeing TPA-managed bodily injury, PIP, and property damage rideshare claims. Controlling litigation costs and improving claims outcomes for specialty insurer Crum & Forster.
Executive Claims Specialist, PIP
Executive Claims Specialist providing technical oversight of PIP/no-fault claims for Crum & Forster’s specialty insurance programs. Auditing TPA claim handling, evaluating complex exposures and guiding litigation, arbitration and compliance.
Senior Claims Analyst
Senior Claims Analyst handling complex casualty and environmental insurance claims for One80 Intermediaries. Investigating coverage, managing litigation, and resolving claims remotely in Massachusetts.
Senior Workers Comp Claims Specialist
Senior Workers’ Compensation Claims Specialist managing complex California claims for National Interstate, a commercial transportation insurer. Fully remote from the USA, handling investigations, settlements, reserves, and litigation matters.
Claims Adjuster – Commercial Auto Claims
Claims Adjuster managing complex commercial auto, bodily injury, and physical damage claims. Supporting a world-class asset-based carrier’s safety, compliance, litigation, and vendor processes.
Senior Claims Representative – Transportation
Senior claims representative managing complex commercial auto claims for Berkley Small Business Solutions. Handling coverage, investigations, reserves, settlements, vendors, and mentoring across jurisdictions.
Cargo Claims Specialist
Cargo Claims Specialist processing cargo claims for Trinity Logistics’ freight operations. Providing solutions and customer-carrier claims expertise while working remotely.
Claims Examiner II
Claims Examiner II adjudicating healthcare claims for HealthEdge’s health insurance technology platform. Reviewing coding, coverage criteria, and system edits while mentoring team members.