Medical Management Analyst

Formulate and deliver cost management techniques to mitigate losses and improve care.

Maximize vendor usage by Identifying, steering and monitoring catastrophic claims through ARHC?s Care Management system. Coordinate CM efforts with the Claims department

Works as a care management team member to decrease medical loss costs through:

Development/Review of service providers that can provide resources and uniform discounts;

Tracking /measuring/analysis/negotiate discounts from the service providers used by our clients;

Assists American Re HealthCare Claims personnel on audits and daily issues in care management.

Assists Vice President of Medical Management with vendor management selection and evaluation:

Assist underwriting with all aspects involving care management solutions and new products;

Analysis of use of service providers by clients and how to maximize discounts.

Present Care Management & Claims topics to internal and external constituents.

Work closely with underwriting and actuarial departments to evaluate reserves, care management savings estimates and risk adjusting modeling.

Reviews notices from clients and interact with clients to use resources to provide quality/cost effective care.




Requirements:


? BS or BA in Management, Finance or Business related degree
? Knowledge in Healthcare claims administration and adjudication
? Advanced Knowledge of the Healthcare financing systems, including commercial, Medicare and Medicaid.
? Experience in catastrophic healthcare illnesses.
? Strong analytical Skills
? Advanced claims management skills
? Reinsurance experience preferred






To apply online, please use the following link:
Apply To American Reinsurance