What are the responsibilities and job description for the Claims Analyst International - Miami, FL position at Morgan White Group?
The Claims Analyst reports to the Claims Department Manager of the MWG-International Division. The position is a non-exempt, hourly role and is located at 75 Valencia Avenue, Suite801, Coral Gables, Florida 33134.
GENERAL JOB DUTIES AND RESPONSIBILITIES :
To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Processing and adjudication of claims which includes
- Opening and labeling the claim files once the claims have been assigned
- Photocopying / scanning the claims for proper file maintenance
- Analyzing the claims to proper adjudicate it according to the policy coverage and limitations
- Submit claims for service rendered in USA for reprising.
- Responsible for all email and phone calls with clients and agents regarding the assigned cases
- Responsible for investigating any medical information need it to proper process the case.
- Create letters to providers (USA, Latin American and / or the Caribbean) requesting specific information or providing them information or explanation on a claim processed.
- Responsible for writing and submitting letters of denial (temporarily of permanent) as well of letters of exclusionary riders or cancellation of coverage to the Insureds when necessary.
- Prepare medical evaluations for cases on excess of $100,000 or on any cases in which a retroactive exclusionary rider needs to be applied.
- Communicate to Insureds on a formal letter of any Lloyd's decision regarding an appeal of a claim.
- Report to Raul Pozo and Dr. Waldo Suarez of any claim on excess of $10,000 for approval.
- Discuss claims cases as need it with Dr. Suarez, Raul Pozo and Luyen Vivar
- Review on every check run that all the payments processed during the week are correct and print report for check run processor.
- Responsible for reviewing and paying ORNOA'S invoices for those patients assigned, that seek medical treatment in Miami thru the patient navigation service.
- Responsible for keeping, maintaining and filing all the information for cases assigned until the process of claims payments and adjudication is completed.
EXPERIENCE AND EDUCATION REQUIREMENTS :
WORKING ENVIRONMENT :
JOB ESSENTIAL REQUIREMENTS :
The following are job functions that an employee must be capable of performing with or without reasonable accommodation.
REASONABLE ACCOMODATIONS :
Morgan White Group will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job, unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation or if the accommodation creates an undue hardship to Morgan White Group.
EQUAL OPPORTUNITY EMPLOYER :
MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Salary : $100,000
