About this role
<p><span style="font-size:10.0pt;color:black">Odyssey Reinsurance Company (OdysseyRe) is the global reinsurance arm of Odyssey Group, one of the world’s leading providers of reinsurance and specialty insurance. OdysseyRe offers a broad range of property, casualty, and specialty reinsurance products, providing capital and risk management solutions for clients to efficiently manage economic risk, through a network of branch and representative offices across North America, Latin America, EMEA (Europe, Middle East & Africa), AsiaPacific and London.</span></p> <p> </p> <p><span style="font-size:10.0pt;color:black">OdysseyRe is an equal opportunity employer with excellent benefits and a strong commitment to providing training and opportunities for our staff. We provide employees an innovative, enriching environment and take great pride in their career growth.</span></p> <p> </p> <p><span style="font-size:10.0pt;color:black">OdysseyRe is rated A+ (Superior) by AM Best and AA- (Very Strong) by Standard and Poor’s. Odyssey Group is a subsidiary of Fairfax Financial Holdings Limited, which is traded on the Toronto Stock Exchange under the symbol FFH.</span></p> <p> </p><p><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black"><strong>Summary</strong></span></p> <p><span style="font-size:10.0pt;background-color:white;color:black">Responsible for reviewing and adjudicating medical claims to ensure accurate, timely reimbursement, interpreting contract provisions and eligibility requirements, researching fee schedules, and collaborating with claims staff, underwriters, and brokers to resolve inquiries and support claims-related decisions.</span></p> <p> </p> <p><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black"><strong>Responsibilities</strong></span></p> <ul type="disc"> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Adjudicate claims for timely review and appropriate reimbursement</span></li> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Analyze claims data to determine eligibility and apply appropriate contract provisions to the medical facts of the claim</span></li> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Work with claims staff, underwriters, and advise brokers on adjudication results and resolve claim inquiries</span></li> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Provide support for inquiries on adjudication methods and outcomes to claims staff</span></li> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Research and review state reimbursement fee schedules</span></li> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Other support requirements, as necessary</span></li> </ul> <p> </p> <p><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black"><strong>Qualifications</strong></span></p> <ul type="disc"> <li style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;color:black"><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black">Bachelor’s degree (or equivalent college education)</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;color:black"> <div><span style="font-size:10.0pt;background-color:white;color:black">10+ years of claims adjudication, claims processing, health insurance, or related experience</span></div> </li> <li style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;color:black"><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black">Strong attention to detail and organizational skills</span></li> <li style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;color:black"> <div><span style="font-size:10.0pt;background-color:white;color:black">Knowledge of medical terminology, insurance benefits, and claims adjudication principles</span></div> </li> <li style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;color:black"> <div><span style="font-size:10.0pt;background-color:white;color:black">Ability to interpret plan documents, contract provisions, eligibility requirements, and reimbursement guidelines</span></div> </li> <li style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;color:black"><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black">Clear written and verbal communication skills</span></li> <li style="font-size:10.0pt;color:black"><span style="font-size:10.0pt;background-color:white;color:black">Ability to work well independently as well as within a team environment</span></li> <li style="font-size:10.0pt;color:black"><span style="font-family:arial, helvetica, sans-serif;font-size:10.0pt;background-color:white;color:black">Proficiency (Microsoft Office Product Suite)</span></li> </ul><p> </p> <p><span style="font-size:10.0pt;color:black">We are an E-Verify employer - all hired positions require successfully passing an E-Verify Check. </span></p> <p> </p> <p><span style="font-size:10.0pt;color:black">Navigate the links below to learn more about careers at OdysseyRe:</span></p> <p><span style="font-size:10.0pt"><a href="http://odysseyre.com/careers/" target="_blank" rel="noopener"><em>Workplace Initiatives</em></a></span></p> <p><span style="font-size:10.0pt"><em>Follow us on <a href="http://www.linkedin.com/company/odyssey-re/" target="_blank" rel="noopener">LinkedIn</a> for company highlights</em> </span></p>