Senior Stop Loss Claims Auditor
Description
Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier.
Recognize cost mitigation opportunities.
Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.
Initiate claims investigations and vendor referrals.
Interpret plan language, and identify experimental services and subrogation opportunities.
Identify need for follow-up on pended claims and resolution.
Communicate effectively with carriers, vendors, and management.
Provide full claims service to both phone and written inquiries.
Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history.
Develop new and review old stop loss claim forms.
Assist with internal auditing of claims auditors, and training of claims auditors.
What You’ll Do
Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier.
Recognize cost mitigation opportunities.
Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.
Initiate claims investigations and vendor referrals.
Interpret plan language, and identify experimental services and subrogation opportunities.
Identify need for follow-up on pended claims and resolution.
Communicate effectively with carriers, vendors, and management.
Provide full claims service to both phone and written inquiries.
Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history.
Develop new and review old stop loss claim forms.
Assist with internal auditing of claims auditors, and training of claims auditors.
Qualifications
- Associate's Degree Equivalency: 2 years of job-related work experience
- Required Work Experience: 6 years of managed care or reinsurance claims experience
Preferred Skills and Abilities
- Analyzes laws, regulations and contract language.
- Evaluates issues and develops recommendations.
- Handles confidential and sensitive information.
- Investigates assigned claims.
- Proposes claims adjustments and refunds.
- Works claims caseloads.
- Agregate claims experience.
Benefits
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- National discounts to movies, theaters, zoos, theme parks and more