As a Analyst, Claims Adherence, you will conduct accurate and timely reviews of high-risk situations requiring impartial and unbiased investigations. You will also provide recommendations to support consistent claims adjudication and ensure fair, equitable outcomes, with a focus on claims-related insurance fraud.At Trupanion, we believe a flexible workplace! We know that talented pet-loving professionals are everywhere. This is a remote position open to candidates anywhere in the US. You must be able to have a reliable/stable connection to the internet through hard-wire Ethernet. If you enjoy a mix of on-site and remote work, you may choose to have a hybrid schedule in our Seattle office.ScheduleMonday to Friday from 7:00 a.m. PDT to 3:00 p.m. PDT.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: As a Analyst, Claims Adherence, you will have the authority to: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.
