Morgan White Group · 16 hours ago
Claims Analyst International - Miami, FL
Coral Gables, FL, USA
Full-time
Onsite
Entry Level
1+ years expMorgan White Group is seeking a Claims Analyst for their MWG-International Division. The role involves processing and adjudicating claims, managing client communications, and ensuring proper documentation and compliance with policy coverage.
Financial ServicesHealth CareInsurance
Responsibilities
Processing and adjudication of claims which includes
Opening and labeling the claim files once the claims have been assigned
Photocopying/ scanning the claims for proper file maintenance
Analyzing the claims to proper adjudicate it according to the policy coverage and limitations
Submit claims for service rendered in USA for reprising
Responsible for all email and phone calls with clients and agents regarding the assigned cases
Responsible for investigating any medical information need it to proper process the case
Create letters to providers (USA, Latin American and/or the Caribbean) requesting specific information or providing them information or explanation on a claim processed
Responsible for writing and submitting letters of denial (temporarily of permanent) as well of letters of exclusionary riders or cancellation of coverage to the Insureds when necessary
Prepare medical evaluations for cases on excess of $100,000 or on any cases in which a retroactive exclusionary rider needs to be applied
Communicate to Insureds on a formal letter of any Lloyd's decision regarding an appeal of a claim
Report to Raul Pozo and Dr. Waldo Suarez of any claim on excess of $10,000 for approval
Discuss claims cases as need it with Dr. Suarez, Raul Pozo and Luyen Vivar
Review on every check run that all the payments processed during the week are correct and print report for check run processor
Responsible for reviewing and paying ORNOA'S invoices for those patients assigned, that seek medical treatment in Miami thru the patient navigation service
Responsible for keeping, maintaining and filing all the information for cases assigned until the process of claims payments and adjudication is completed
Qualification
Required
Requires high school diploma or general education degree or equivalent or 1 year of related experience
Communication skills – verbal, written and listening skills
Knowledge of Microsoft outlook, excel and word
Each employee must pass a drug screen
Positive reports must be received from a criminal background investigation and review of working references
Must be capable of maintaining regular attendance
Must be capable of performing the essential job functions of the position, with or without reasonable accommodations
BILINGUAL REQUIRED: Must be able to read, write, and speak English and Spanish
Must have basic typing skills
Must be able to work as scheduled
Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met
Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday
Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs
Company
Morgan White Group
Morgan White Group is an insurance company offering brokerage services, dental, and vision insurance products.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
David R. White, RHU
Chief Executive Officer
Ryan Eaton
Executive Vice President, Chief Marketing Officer
Company data provided by crunchbase