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Hybrid Claims Analyst

at Tenchijin
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Posted 3 weeks ago

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About the role

  • Review incoming out-of-network fee reimbursement claims from our legal plan members for all aspects of accuracy.
  • Make determinations resulting from these reviews and prepare these claims for payment or forward the claims to in-house counsel for further analysis and determination.
  • Internal/external communications between our in-house counsel and our MetLife Legal Plans members.
  • Review billings received from our Panel Attorneys for services provided to our legal plan members, including analyzing a billing for correct coding, appropriate fees and specific required information completed.
  • Make necessary corrections to these billings and continue with the billing payment process or decide if additional review and determination from in-house counsel is required.
  • Perform an analysis of Attorney’s billings and determine necessary adjustments.
  • Work closely with the Accounting department to recover Panel Attorney overpayments.
  • Put Attorney billings on hold when further payment decisions or backup are needed.
  • Release Attorney billings from hold status when billing criteria is complete.
  • Determine appropriate billing noteline for payment and audit purposes.
  • Reconcile and resolve billing payment cycle audit discrepancies.
  • Process a reconciliation “close” and send billings to Accounting department for final approval for payment release.
  • Analyze claims for reimbursement of out-of-network attorney services.
  • Complete claim form and ensuring that coverage of the member’s specific legal plan are correctly identified, determine if proper backup and payment receipts have been included with claim.
  • Keep all levels of member information secure during processing.
  • Determine when a claim needs to have further approvals and communicate the need to the appropriate individuals.
  • Update various spreadsheets for tracking purposes and perform Fee Reimbursement reconciliation close process using IBMi queries and/or other MetLife Legal Plans systems to release claims for payment.
  • Resolve discrepancies during Fee Reimbursement close process.
  • Communicate with legal plan members on answers to their questions and status of their reimbursements.

Requirements

  • Bachelor’s degree from an accredited university or equivalent work experience
  • Strongly prefer the candidate to have an Active Adjusters License for multiple states within the United States.
  • 3+ years of experience in claims, settlements or accounts receivable.
  • Ability to multitask and work with a sense of urgency while maintaining attention to detail
  • Ability to meet assigned aggressive deadlines
  • Detail-oriented and well-organized, with the ability to effectively manage a high-volume workload
  • Self-motivated with the ability to take initiative and work independently as well as with a team
  • Ability to communicate effectively and professionally with our legal plan members and internally with other company associates
  • Proficiency with Outlook and Microsoft Office products including Excel and Microsoft Word
  • Previous experience in accounting or business processes
  • Knowledge of legal industry or business
  • Strong attention to detail and excellent organizational skills
  • Ability to work within a team environment

Benefits

  • Health insurance
  • Flexible work arrangements
  • Professional development opportunities
  • Paid time off

Job title

Claims Analyst

Job type

Full Time

Experience level

Mid levelSenior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

HybridClevelandUnited States

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