Full-Time Analyst, Claims Adherence

As a Analyst, Claims Adherence, you will conduct accurate and timely reviews of high-risk situations requiring impartial and unbiased investigations.

You will provide recommendations to support consistent claims adjudication and ensure fair, equitable outcomes, with a focus on claims-related insurance fraud.

Key Responsibilities Include:

• Understanding and translating complex data into meaningful actions and clear communications.
• Assisting in risk mitigation reviews, including fraud investigations, and making informed recommendations to prevent, intercept, and mitigate fraud.
• Interpreting and applying insurance policies to claims.
• Extracting, interpreting, and converting raw data into plain language and formal written report recommendations.
• Providing exceptional customer service to members, hospitals, and internal teams at Trupanion.
• Assisting with internal and external audits of all Trupanion-administered products.

Decision Making Authority:

• Make eligibility decisions on claims and appeals.
• Authorize payments on claims with subtotals under $40K.
• Reopen or interrupt payments on claims processed by others for assessment and payout validation.
• Request or conduct additional information gathering or validation tasks related to those claims.

Education, Registration & Certification:

• Licensed Veterinary Technician credentials preferred, or equivalent experience in a veterinarian clinic
• Currently licensed or ability to obtain property and casualty adjuster license in Canada and/or the United States

Experience:

• 3+ years of experience related to P&C (Property and Casualty) or pet insurance.
• Veterinary technician or assisting experience in a clinic/hospital environment is a plus.

Education or certification in insurance operations, insurance fraud detection and investigation, or risk management is a plus.

Skills, Knowledge & Abilities:

• Knowledge of veterinary practice operations and medicine, including medical terminology and conditions.
• Strong desire to contribute to an evolving team with shared goals around group performance.
• Ability to work creatively and adapt to shifting processes and goals.
• Desire to collaborate and help develop a wide variety of processes over time.
• Knowledge of Trupanion policies.
• Proficiency with Microsoft Office applications and Trupanion applications.
• Effective communicator (written and spoken).
• Problem-solving skills in high-pressure situations.
• Strong attention to detail.
• Ability to work both independently and as part of a team.

What is the last date for applying to the job?

Which countries are accepted for this remote job?