Hybrid Claims Analyst

at Tenchijin

• Job title: Claims Analyst
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Cleveland, United States

About the role

• Claims Analyst reviewing out-of-network reimbursement claims for MetLife Legal Plans. Collaborating with legal team and ensuring claims are processed correctly with high attention to detail.

Responsibilities

• 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