Insurance & Claims Management Specialist

Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs. 

The Specialist will be expected to provide actionable claim analysis reporting including on-going analysis of historical claims and expected trends moving forward. This individual should be able to provide insight and guidance to various stakeholders aimed at strengthening safety efforts across the health system and developing risk mitigation programs.

In support of the insurance function, the Specialist will assist in insurance renewal and maintenance tasks such as collecting accurate underwriting data, tracking policies, certificates of insurance, and maintaining up to date exposure data including but not limited to the rosters for all healthcare providers, schedules of property, and insurance summaries. The Specialist will coordinate and execute on insurance renewals, new coverage placements, actuarial assessments, and financial audits with the goal of achieving excellent outcomes.

The Insurance & Claims Management Specialist will have frequent interactions with Finance, Operations, Compliance and Leadership throughout the Health System. The role will report to the Chief Risk & Quality Officer with a matrix to the Chief Financial Officer.

Roles And Responsibilities

• Claims Management:
• Handle incoming claim inquiries for all coverage lines, intake details, and escalated claims;
• Maintain claims records, history, loss runs, related correspondence, and documentation;
• Track claim progress, and monitor status of denied claims and appeals;
• Provide timely reports to management on claim status and potential areas for mitigation;
• Analyze claim trends, and root cause analysis;
• Identify and implement claim process improvements;
• Work with adjusters to move claims to resolution through monitoring claim status and providing requested information in a timely manner.
  
  

• General Insurance & Administration:
• Co-manage the organization's insurance portfolio, including general liability, medical professional liability, worker's compensation, auto, and property insurance;
• Assist with insurance renewals and new placements;
• Track and maintain certificate of insurance, insurance policies, and endorsements;
• Keep up to date insurance exposure information and perform data entry to maintain accurate client information;
• Assist with policy audits and other insurance financial calculations including respective claim amounts to issue premiums, adjustments, refunds, and more;
• Maintain accurate and up-to-date rosters of insured healthcare providers and program information across all CHS entities;
• Respond to requests for medical professional liability information.
  
  

• Patient Safety and Risk Reduction
• Acts as primary contact with CHS for data and technical assistance from a variety of computer systems maintained for all facilities
• Guides and serves as health system liaison with other data analysts and RM support personnel from within CHS facilities;
• Develops common report templates and assists in the generation and information gathering.
• Maintains audit records for various internal use.
• Participates in committee meetings as required.
  

Required Skills And Experience

• Bachelor's degree in Risk Management, Insurance, Healthcare Administration, or a related field.
• 3-5 years of experience in risk management or insurance, preferably within the healthcare industry.
• Claims management experience as an adjuster or similar role, preferably with a background in self-insured plans and experience working with a TPA.
• In-depth knowledge of insurance policies including but not limited to Healthcare Professional Liability, Worker's Compensation, General Liability, and Auto.
• Strong analytical skills with the ability to assess complex risk scenarios, designs workflows and procedures.
• Data analysis and advanced skills in performing data exercises in Microsoft Excel and/or related programs.
• Articulates thoughts and ideas effectively both verbally and in writing.
• Presents information effectively in a variety of settings.
• Demonstrates ability to maintain complex information in an organized manner supporting process efficiency.
• Displays creativity and pro-actively seeks ways to improve upon current processes and makes recommendations.
  
  

Physical Requirements

• This position primarily involves sedentary work. The incumbent will typically perform tasks while seated at a desk or workstation, utilizing computers, phones, and other office equipment. Sedentary work may require occasional standing, walking, or light physical effort, but the majority of duties will be performed in a seated position. Reasonable accommodation may be made to enable individuals with disabilities to perform essential job functions.
  
  

Location and Travel Requirements:

• Hybrid
• Travel to Cayuga Health System (CHS) locations for various meetings, events, and collaborations will be required. This may include periodic visits to our facilities in Ithaca, New York, and surrounding areas. Travel frequency will depend on organizational needs, project requirements, and scheduled events. The incumbent should be flexible and able to accommodate occasional travel as necessary to effectively fulfill the duties and responsibilities of the role.
  
  

Pay Range Disclosure

• $55,000 to $75,000 per year
  
  

Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.

We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.

If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at talentacquisition@cayugahealth.org.

I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added, or interpreted at any time, at the company's sole option and without prior notice to me.

I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment/post-offer checks, which may include a background check, drug screen, employment references, and licensing review. If I am made a conditional offer of employment, I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment/post-offer checks. Such checks will not be conducted until allowed under applicable federal, state, and local law. I understand if I have a criminal background, it will not automatically disqualify me from employment unless otherwise required by law. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.

I also understand that the Company is a drug and alcohol-free workplace and has a drug and alcohol testing program consistent with applicable federal, state, and local law. I understand that after a conditional offer of employment, I must submit to and pass a pre-employment drug test as a condition of employment.

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