Claims Quality Audit Manager jobs in Lawrence, MA

Why Jencap? We are one of the largest wholesale insurance intermediaries in the United States with expertise in wholesale brokerage, binding authority, and program management. The common thread woven throughout our success story is our collaborative and driven team of people. Our teams are empowered and work together to find solutions. We have a passion culture – with teamwork, collaboration and a focus on growing individuals and giving them the tools & development opportunities to have a successful career. 

HRMP, a Jencap company, is a third-party administrator for risk takers and is uniquely positioned to offer business solutions to carriers, reinsurers, and underwriters. We provide a variety of services and solutions within the insurance market such as stop-loss program administration, group life and medical conversions, auditing services, back office or run-out administration, quota share and excess medical reinsurance. 

The Claims Manager supports medical insurance customers (including administrators, MGUS, brokers) by confirming eligibility, determining insurance coverage, examining and resolving medical stop loss claims, documenting actions, maintaining quality customer service, ensuring compliance.

This role will work a hybrid schedule reporting to our Jencap office in Danvers, MA. 

Responsibilities: 

• Establishes proof of loss by reviewing medical documentation presented, requesting additional information from sources such as (administrator, broker, hospital, physician etc.)
• Adjudicates claims in medical stop loss system (ESL) and or (UGAN) approving, denying based on compliance with SPD and Stop loss policy.
• Reports to client regarding reimbursements and in turn forwards to accounting department for reimbursement
• Maintains quality client service by responding timely and accurately to client inquiries maintaining client expected turn-around time
• Prepares standard and ad hoc reports
• Maintains confidentiality and comply with Health Insurance Portability and Accountability Act  (HIPAA)

Requirements:  

• College degree or a minimum of five (5) years medical stop loss claims processing.  
• Strong written and verbal communication skills.
• Working knowledge of David Young (ESL System) and or Kevin Ugan system.
• Flexibility to handle multiple priorities while maintaining high level of professionalism.
• Must be able to work well independently or in a team environment. 
• Knowledge of CPT/HCPC, Revenue and ICD9 to ICD10 coding procedures and guidelines

Want the opportunity to build something new? Expand your knowledge and stretch your experience through new and emerging risks? Have your voice heard, your skills properly applied, and to add tangible value to an organization? You’re in the right place. 

Jencap is dynamic, bold, tenacious, and trusted in the industry. Here, you are not just one of the many, you are one of us.  We truly are better together. 

The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The base pay range for the Claims Manager will be $95,000 . Discretionary incentive compensation may be awarded. Jencap also offers a range of benefits and programs, based on eligibility, which currently include but are not limited to; comprehensive health care coverage, a 401k plan, and tuition reimbursement.  Jencap is an emerging and rapidly growing leader in the industry and as such, we approach talent acquisition as an opportunity to identify the best talent. Therefore, the level of the role and compensation may vary depending upon the best available candidate. 

Jencap is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin or citizenship status, sexual orientation, gender identity or expression, pregnancy, marital or familial status, disability status, medical condition, genetic information, military or veteran status, political affiliation, or any other characteristic protected by law. We are committed to fostering a work community where every colleague feels welcomed, valued, respected and heard, as we believe that that creating an environment where every employee feels included and empowered, helps us to deliver the best outcome to our clients.