Reinsurance Director jobs in Clackamas, OR

Reinsurance Director is responsible for the administration of reinsurance plans. Maintains plan records and ensures compliance with federal regulations. Being a Reinsurance Director communicates with customers and assists with plan design and distribution when necessary. Ensures timely accounting, reporting and auditing. Additionally, Reinsurance Director researches and analyzes reinsurance prices and specifications. Communicates with underwriting area to verify the proper reinsurance administration is put in place. Supports the investigation of proposed reinsurance opportunities, rate comparisons, and profitability analysis. May have responsibility for reinsurance customer service. Has attained industry designations. Requires a bachelor's degree. Typically reports to top management. The Reinsurance Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Reinsurance Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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Reinsurance Coordinator
  • Moda Health
  • Milwaukie, OR FULL_TIME
  • Let’s do great things, together!

    Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

    Job Summary:
    This position facilitates and coordinates all activities associated with the monitoring, advance notification, and filing of high dollar claims for reinsurance.  Responsible for the development and maintenance of cross-departmental reinsurance policies, procedures, and guidelines.
    ​​​​​
    Moda has contracts to hire candidates from the below States ONLY. This a full-time remote position for candidates living or willing to relocate to the following States ONLY: AK, AZ, FL, ID, OR, or WA.

    ​​​​Please follow the link below to apply to this position:

    • https://j.brt.mv/jb.do?reqGK=27709024&refresh=true
    ​​​Benefits:
    • Medical, Dental, Vision, Pharmacy, Life, & Disability
    • 401K- Matching
    • FSA
    • Employee Assistance Program
    • PTO and Company Paid Holidays
    Schedule:
    • PST
    • Full time minimum 7.5 work days with 37.5 work weeks

    Primary Functions:

    1. Identify, evaluate, track and monitor reports for potential high dollar cases and provide advance notification to the reinsurer as required by the contract.
    2. Effectively communicate with Healthcare Services staff regarding high dollar cases.
    3. Prepare and research all reinsurance claims and submit monthly claims to the reinsurance carrier once a member has exceeded the stop loss for the current year. 
    4. Maintain a high level of accuracy when reconciling high dollar claims data totals, from more than one reporting system, in a timely manner
    5. Update High Dollar Report information shared by various departments throughout Moda Health, on an on-going basis.
    6. Act as a liaison between Healthcare Services staff, claims, the reinsurance carrier, and broker to ensure complete and accurate information is submitted in a timely and accurate manner.
    7. Develop, update, and maintain reinsurance documentation and resource materials as needed to ensure information is current and up to date.
    8. Facilitate quarterly reinsurance meetings and participate in other internal work groups and committees. 
    9. Attend external monthly meetings with reinsurance carriers, brokers, and insured groups to provide support, address cost containment, and coordinate carrier efforts to set reserves.
    10. Receive and interpret reinsurance contract language for each line of business.  Enact and confirm Moda Health compliance with existing agreements.
    11. Contribute to annual contract renewals by supplying accurate disclosure information and context on member costs to stakeholders in contract negotiations.
    12. Participate in the testing, tracking, and implementation of individual high risk reinsurance pools to remain compliant with the rules for each state of operation.
    13. Provide support and assist with audits, both internal and external, as necessary.
    14. Review reimbursement explanations from reinsurance carriers, tracking amounts received, and triaging any pended or denied amounts in accordance with terms of the contract.
    15. On-going communication with staff from Corporate Accounting and Corporate Data, providing accurate information on claims submitted for reinsurance and the claims dollars recovered.   Work reconciliations from Accounting on a quarterly basis as part of MAR controls.
    16. Research and gather factual reinsurance claims issues and identify complex issues which should be referred to Supervisor and/or Manager.
    17. Assist with drafting correspondence regarding reinsurance coverage and claims related issues.
    18. Assist the assigned team with audit duties and responsibilities as determined by the Supervisor and/or Manager, as time permits.
    19. Perform other duties as assigned
    Required Skills, Experience & Education:
    1. High school diploma or equivalent.  Degree in a health-related field preferred.
    2. One to two years’ medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
    3. Knowledge and understanding of Moda Health’s contracts and administrative policies affecting claims and customer service.
    4. Strong Microsoft Excel and other Microsoft Office applications.
    5. Excellent reading, oral, and written communication skills, and ability to interact professionally, patiently, and courteously.
    6. Good analytical, problem solving, decision making, organizational, and detail-oriented skills with ability to shift priorities. 
    7. Demonstrated strong, effective, and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.
    8. Ability to work well under pressure in a complex and rapidly changing    environment.
    9. Always maintain confidentiality and project a professional business presence and appearance
    10. Demonstrated consistent ability to comply with company rules and policies.
    11. Maintain attendance above company standards.
    12. Adheres to all other company policies and procedures.

    Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

    For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.

  • 21 Days Ago

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Director
  • Little Einsteins Spanish School
  • Beaverton, OR FULL_TIME
  • Responsibilities:- Develop and implement strategic plans and initiatives to achieve the organization's goals and objectives- Provide leadership and guidance to staff members, ensuring effective commun...
  • 28 Days Ago

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ACTIVITIES DIRECTOR
  • YMCA of Columbia Willamette
  • Gresham, OR FULL_TIME
  • Description POSITION SUMMARY The Activities Director, under the direction of the Assistant Program Director, is responsible for planning, organizing, and overseeing a wide range of camp activities. Th...
  • 18 Days Ago

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Regional Director
  • Thrive Communities
  • Portland, OR FULL_TIME
  • Feel Seen at Thrive! Company Information: www.thrivecommunities.com Salary: $150,000 - $170,000 Schedule: Full-time Our purpose is to create a community where people feel seen, because we believe when...
  • 18 Days Ago

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Director Nursing
  • SAGE
  • Portland, OR FULL_TIME
  • WE’RE NOT A TYPICAL SENIOR FACILITY We do wellness . . . . not activities. We care about people . . . . . not numbers. We are concerned about residents’ needs. . . . . not their income. We want a nurs...
  • 18 Days Ago

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Budget Director
  • Portland Community College
  • Portland, OR FULL_TIME
  • Under the direction of the Associate Vice President of Finance, the Budget Director manages the day-to-day operations of the Budget Office. Plans, organizes, and manages applicable functional areas in...
  • 18 Days Ago

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0 Reinsurance Director jobs found in Clackamas, OR area

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Director of Nursing
  • Clinical Management Consultants
  • Portland, OR
  • An Ambulatory Surgery Center, located in an affluent, safe, and family-friendly city southwest of Portland, OR, is seeki...
  • 3/28/2024 12:00:00 AM

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Executive Director
  • RIVER VIEW CEMETERY INC
  • Portland, OR
  • Overview To lead a 143-year-old, not-for-profit endowment care cemetery, for-profit funeral home and foundation in Portl...
  • 3/27/2024 12:00:00 AM

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Director of Nursing
  • Sage Search Group
  • Portland, OR
  • Some insight into the company: They are a privately held company, manages senior living and health care communities, res...
  • 3/26/2024 12:00:00 AM

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IT Director
  • Ledgent Technology
  • Wilsonville, OR
  • IT Director Wilsonville, OR (MUST BE LOCAL) 135-150k PLUS BONUS (DOE and Education) Direct Hire-Full Time . Ledgent Tech...
  • 3/26/2024 12:00:00 AM

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Executive Director - OR
  • Circular Action Alliance
  • Portland, OR
  • The Company Circular Action Alliance (CAA), a 501(c)3, is poised to be a leader in changing how packaging is designed, r...
  • 3/25/2024 12:00:00 AM

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Executive Director
  • Careerbuilder
  • Portland, OR
  • Benefits: COLT provides a competitive benefits package, including 100% employer-paid health, vision, and dental coverage...
  • 3/25/2024 12:00:00 AM

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Executive Director
  • NVISION Eye Centers
  • Portland, OR
  • Overview: NVISION Eye Centers, a prominent provider of ophthalmic physician services, is seeking a dynamic and seasoned ...
  • 3/25/2024 12:00:00 AM

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Executive Director
  • Private Posting
  • Vancouver, WA
  • Job Description Job Description Our client is a well-established leader in the Pacific Northwest for senior living accom...
  • 3/24/2024 12:00:00 AM

Clackamas is an unincorporated community and former census-designated place (CDP) in Clackamas County, Oregon, United States and is a suburb of Portland. The population was approximately seven thousand in 2010. Clackamas is home to Camp Withycombe, which is a military base, and to a branch of the Kaiser Permanente Hospital. Clackamas is part of the Portland Metropolitan Area and lies approximately 10 miles (16 km) southeast of downtown Portland and to the east of Interstate 205 along Oregon Routes 212 and 224 and to the north of the Clackamas River. According to the United States Census Bureau...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Reinsurance Director jobs
$120,567 to $173,241
Clackamas, Oregon area prices
were up 3.9% from a year ago

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