Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is a health insurance organization focused on health care delivery and community investment. The Client Financial Analyst is responsible for claims expense invoicing, reporting, analysis, forecasting, reconciliations, stop-loss coverage, and financial consulting, while supporting audits, operational quality reviews, and complex eligibility inquiries.
Responsibilities
- Develop, analyze, interpret, report, and present historical and/or forecasted financial claims expense and stop loss coverage information
- Prepare claims expense financials, estimated claim expense and financial forecasts. Prepare financial and business-related analysis and research
- Coordinate and direct the preparation of stop loss coverage for employer groups or stop loss vendors based on actual high dollar claims and/or claimants’ performance, previous stop loss credits, estimated claims expense, expense reports and other factors
- Prepare reports and analysis for various audiences such as Self-Funded Groups (Employer), Stop Loss Vendors, Sales, Underwriting, etc. Responsible for monthly variance analysis (at employer group level or consolidated company level)
- Act as a consultant for management on financial policy, procedure and application as well as historical, plan and forecasting
- Review and check for accuracy of various internal and external reports, such as membership, commissions, and the impact of large claims on the administrative services and stop loss coverage for use in financial analysis
- Prepare employer group transactions and Statement of account reconciliations, assist with the monthly, run out and final close out activities, prepare schedules and other general accounting functions
- Process a variety of client transactions that may include suspended and/or hold of claims, Run out administrative fees, and/or employer group settlement
- Determine benefit eligibility for stop loss coverage on claims for specific claimants based on contract terms. Includes a variety of stop loss vendor transactions such as inquiries regarding utilization, provider information, medical reviews, Leave of absence language, COBRA benefits, and plan documentation
- Act as a point of contact for internal and/or external audits and projects as necessary; assist in planning, scoping, testing, training and implementation
- Perform quality reviews of operational inquiries to determine the accuracy of information provided and ensure employees are functioning at the expected level of service to enhance customer satisfaction. Communicate the results of the reviews to improve individual and overall performance and make recommendations for coaching and training as necessary
- Handle more complex problems of eligibility and documentation with producers. May provide additional information to underwriting staff when submitting referrals for exception consideration
Skills
- Bachelor's degree or advanced degree (where required)
- 3+ years of experience in related field
- In lieu of degree, 5+ years of experience in related field
- Experience analyzing and interpreting data to support business decisions
- Experience presenting information to clients, customers, or business stakeholders
- Proficiency with Microsoft Excel and other data analysis tools
- Strong written and verbal communication skills
- Demonstrated ability to manage multiple priorities and deadlines simultaneously
- Background working with healthcare, insurance, claims, or benefits-related data
- Proven experience with stop-loss coverage concepts preferred
- Experience supporting external clients or customer-facing business functions
Benefits
- Annual Incentive Bonus based on annual corporate goal achievement and individual performance
- 401(k) with employer match, including an annual company contribution
- Paid Time Off (PTO)
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continued education
- Work-life balance, flexibility, and autonomy
- Remote-Flex work arrangement with virtual work and a few in-office visits each year
Company Overview