Claims Analyst

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, Suite
801, Coral Gables, Florida 33134.

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 accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Processing and adjudication.
• Analyzing the claims to properly adjudicate it according to the policy benefits and limitations.
• Responsible for all emails and phone calls with clients and agents regarding the assigned cases.
• Responsible for investigating any medical information needed to properly process a claim by requesting medical records or any other document needed to providers and/or insureds (USA, Latin American and/or the Caribbean) to make a determination on the claim submitted.
• Responsible for writing and submitting letters of denial to insureds, letters of exclusionary riders or cancellation of coverage to the Insured when necessary.
• Prepare medical evaluations for cases on excess of $ or on any cases in which a retroactive exclusionary rider needs to be applied.
• Communicate to Insured on a formal letter of any Lloyd’s decision regarding an appeal of a claim.

• Requires high school diploma or general education degree or equivalent or 1 year of related experience.
• Medical knowledge to be able to analyze a medical claim submitted to determine eligibility.
• Communication skills – verbal, written and listening skills
• Knowledge of Microsoft outlook, excel and word.
• Each employee must pass a drug screen.
• Reports must be received from criminal background investigation and review of work 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

• 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.

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.

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.

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.