Best Life & Health Insurance Company Work Values

Daily Duties at Best Life & Health Insurance Company:

Business Analyst • Analyze and recommend procedures and guidelines for Fully Insured and Reinsurance products for the entire organization. • Evaluate the quality of systems and recommend effective utilization of resources. • Research and analyze functions, operations, policies, procedures, and regulations. • Develop recommendations to management on system controls, security and operational effectiveness for proposed changes to existing systems. • Proactively identify new solutions to problems. Corporate Auditor, Reinsurance Auditor, Claims Analyst • Develop compliance audit programs for existing Reinsurance and Fully Insured products, such as Medical, Dental, and Vision. • Report on individual audit, providing background information, scope of audit, their significant findings, conclusion and recommendations. • Maximize my audit technique experience as I take audit results and transform them into training recommendations. • Prepare analysis/reports based on audit results, including recommendation for corrective action. • Develop fraud control programs to safeguard company’s assets. • Recommend process to handle the escheat checks on unclaimed property • Conduct claims investigation for both Stop Loss and Fully Insured products. • Audit all aspects of paid health care claims processed by the third party administrators based on the current health care insurance plans and employer contracts. • Full responsibility of maintaining and filing the company reinsurance claims and providing a financial report to the management team. • Develop a general check list for our clients to follow from eligibility, claims processing and cost containment issues. • Determine potential risk of loss from the 50% notification reports as based on the review of medical case management notes, operative reports, and other medical records. • Analyze potential catastrophic risk and project future reserves for large claims liability for new/renewal business for Stop Loss Underwriting. • Effectively manage potential catastrophic cases and coordinate with care review companies the Utilization Review process in monitoring potential high risk claims. • Pro-actively manage & control cost on large dollar claims for the companies. • Interpret plan documents, employee benefits plans, employer contract provision, employer financial responsibility matrices and current health care regulations. • Review reinsurance contract and amendment language for accuracy and appropriateness. • Review and recommend writing on healthcare claims processing subjects on Fully Insured and Stop Loss products. • Assist Underwriting with new and renewal businesses for potential rating of a case based on the employee benefits and audit findings that were not discloses prior to the inception of business. • Review appeals, subrogation and litigation cases.

What they like about Best Life & Health Insurance Company:

You give high priority to hiring firms with prestige. Market reputation and prestige of a firm may be determined through on-line research, and conversations with individuals working in your target industry. Note that firms "in the public eye" receive a great deal more critical publicity and attention than those operating with more anonymity. So as you assess your employment opportunities, be sure to seek out the positive aspects of the firm's reputation in addition to noting negative publicity the company may have received.

Tags

Auditor, Analyst, Healthcare, Insurance, Economic, Reinsurance, Economics, Claims, Management, Marketing, Trainer , Investigator

Skills

• Microsoft Office (Word, Excel, Access), • WordPerfect, • Lotus Notes, • SQL, • ESL Office from David Young Consulting, I am multi-lingual: English, Vietnamese, and French

These are some of the questions we asked our climbers about their experiences with Best Life & Health Insurance Company: