Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Essential Responsibilities: Maintain expert-level understanding of reinsurance contract terms and provisions; adapt administration processes for new, renewing, and custom self-funded groups. Participate in group meetings to provide guidance on reinsurance requirements and processes. Analyze complex claims and reporting data to identify potential reinsurance cases; initiate Advanced Funding requests when applicable. Audit and adjudicate claims to determine reimbursement eligibility; reconcile discrepancies and ensure accurate documentation. Prepare and submit comprehensive claims packets to carriers; track submissions and manage appeals for denied or pending claims. Accurately post reimbursements and maintain detailed claims accounting, aggregating-specific, and aggregate reinsurance claims. Generate and audit manual and system-based reports for internal and external stakeholders, ensuring accuracy across overlapping contract scenarios. Conduct regular reviews of unpaid claims and facilitate timely adjudication during contract closeout periods. Utilize and interpret various internal reports (e.g., Large Claims, Pre-payment Audit, Reinsurance Reports) to support reinsurance operations. Supporting Responsibilities: Communicate effectively and professionally, both verbally and in writing, with carriers, clients, agents, and internal departments. Actively participate in team meetings and daily team Visual Board huddles. Consistently meet department and company performance and attendance expectations. Adhere strictly to PacificSource's privacy policy and all HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned to support department objectives. SUCCESS PROFILE Work Experience: A minimum of 3 years of claims processing or business analysis experience required. Marketing and/or reinsurance administration experience is preferred. Education, Certificates, Licenses: High School Diploma or equivalent required. Knowledge: Demonstrated expert-level understanding of self-funded products, plan designs, and health insurance terminology. Strong ability to interpret, understand, and apply complex health contracts and reinsurance requirements. High-level knowledge of medical terminology and proficiency in ICD-10 and CPT coding. Exceptional ability to balance multiple complex projects and accomplish tasks accurately under pressure, consistently meeting deadlines. Proven capacity to be self-motivated, think critically, and work independently with minimal supervision. Superior written and verbal communication skills, with the ability to interact professionally and effectively with diverse internal and external customers. Unwavering accountability for the quality and accuracy of all documents, files, and records used to substantiate reinsurance cases. Intermediate to advanced proficiency in Microsoft Office Suite, particularly Excel, Word, and Outlook, along with 10-key accuracy. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time. Skills: Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.