Reinsurance and Ancillary Specialist

Job Description

Job Description

Job Title:  Reinsurance/Ancillary Specialist

Reports To:  Manager, Reinsurance and Ancillary Services

FLSA Status:  Non-Exempt

This is a non-exempt position with subject matter expertise in reinsurance claims administration, short-term disability, and subrogation. The ideal candidate maintains relationships with claims and operations contacts at SIHO's reinsurance carriers and has a strong working knowledge of reinsurance terms and conditions across multiple carriers. This position participates in the daily processes of the Ancillary Services department, reports departmental data to the Manager of Reinsurance and Ancillary, and works cross-functionally with other SIHO departments to build effective, repeatable processes.

The candidate must have strong oral and written communication skills, since the role involves presenting recovery opportunities and analysis, claims follow-up, and communication with account management, clients, brokers, leadership, internal operational teams, and reinsurance vendors. This position processes short-term disability claims weekly, and works daily with SIHO's subrogation vendor, Claritev (formerly MultiPlan), to support subrogation recovery.

Brief Description of Duties:

• Monitor paid claims by member to determine when a reinsurance recovery claim should be filed.
• Identify current and potential reinsurance cases by placing member alerts and routing claims to the reinsurance queue for filing determination.
• File reimbursement requests and Advanced Funding claims with reinsurers in a timely manner.
• Notify reinsurers of 50% specific deductible situations and potentially large claims.
• Perform claims reconciliation across SIHO's core systems and reinsurance platforms, including Ringmaster, identifying and resolving discrepancies in paid claim data, adjustment versions, and claim ID matching.
• Respond to reinsurance carrier and auditor requests, including stop loss audit documentation, within established turnaround times.
• Support onboarding of new reinsurance accounts, including large or multi-group accounts, by coordinating data setup, eligibility loading, and stakeholder communication across departments.
• Process short-term disability claims weekly on Mondays, including intake, eligibility verification, and benefit determination.
• Work daily with Claritev (formerly MultiPlan) to identify, refer, and track subrogation recovery cases.
• Assist in developing workflow documentation for subrogation and short-term disability processes.
• Develop and maintain working relationships with SIHO departments and external vendors to ensure prompt communication on Ancillary Services activity and vendor-related business decisions.
• Develop, maintain, and report statistical measurements assessing the effectiveness of SIHO's reinsurance and ancillary functions.
• Maintain current knowledge of regulations affecting subrogation and short-term disability.
• Other duties as assigned.

Minimum Skills Requirements:

• Bachelor's degree preferred, or equivalent applicable work experience.
• Insurance industry experience preferred; reinsurance, stop loss, or subrogation experience a strong plus.
• Strong analytical skills, including the ability to interpret reinsurance contract language and identify claims trends.
• Proficiency with Microsoft Excel sufficient to reconcile claims data and build exception reports.
• Working knowledge of SIHO's core processing systems and reinsurance platforms (Ringmaster or equivalent).
• Ability to manage a high volume of claims and files across multiple accounts, including complex or multi-group accounts, with accuracy and attention to detail.
• Ability to manage a weekly short-term disability processing cycle against a fixed deadline.
• Strong organizational skills and ability to prioritize competing deadlines.
• Strong internal and external communication skills.
• Ability to develop and improve processes independently.
• Ability to work independently while functioning as a reliable part of the team.
• (Internal candidates) Most recent SIHO performance evaluation of at least "3" (Performance achieved requirements of job).
• General knowledge of the health care industry.
• Understanding of reinsurance policy administration and claims processes.

Our Vision

SIHO aims to redefine what organizations and members expect from their health plan by creating stronger connections, better outcomes, and a more human-centered experience.

Company Description

Our Vision\n\nSIHO aims to redefine what organizations and members expect from their health plan by creating stronger connections, better outcomes, and a more human-centered experience.