The Claims Analyst reports to the Claims Department Manager of the MWG-International Division. The position is a non-exempt, hourly role and is located at 75 Valencia Avenue, Suite801, Coral Gables, Florida 33134.

GENERAL JOB DUTIES AND RESPONSIBILITIES:

To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 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.

EXPERIENCE AND EDUCATION REQUIREMENTS:

• 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

WORKING ENVIRONMENT:

• Must be able to perform in a very high paced environment and professionally handle interruptions.
• Must have the ability to work under minimal supervision.
• Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines.
• Must possess excellent problem-solving skills and have keen attention to details.
• Must demonstrate strong written and verbal communication, interpersonal, and relationship building skills.
• Must be able to handle stressful situations appropriately.
• Must maintain confidentiality and privacy in every aspect of the job.

JOB ESSENTIAL REQUIREMENTS:

The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

• 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.

REASONABLE ACCOMODATIONS:

Morgan White Group will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job, unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation or if the accommodation creates an undue hardship to Morgan White Group.

EQUAL OPPORTUNITY EMPLOYER:

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.