Stop Loss Claims Specialist I-Aggregate

About the role

The Stop Loss Claim Specialist is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers for aggregate coverage. Additional duties include following up with the various carriers to ensure reimbursements are received in time and in full. Further responsibilities include the appeals of denied and reduced claim reimbursements, along with retaining the appropriate documentation needed to support the reimbursement request.

Responsibilities

• Compile and submit claim reports and the necessary documentation to file a stop loss claim.
• Frequently monitor the status of claims assigned and follow up with stop loss carriers.
• Answer questions and requests from stop loss carriers for additional information promptly and with thorough information in support of claim reimbursement.
• Communicate with other internal departments to resolve claim issues.
• Manage time to file aggregate accommodation, level funded and/or final claim submissions per contract stipulations.
• Appeal the denials or reduction of reimbursements by the stop loss carrier.
• Audit the aggregate positions, tracking the funding balance and updated reporting monthly.
• Prepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity.
• Understand stop loss policy provisions, as well as group plan documentation in support of claim reimbursements.
• Adapt to new concepts and systems.
• Other duties as assigned.

Requirements

• High School diploma or equivalent required.
• Some college or equivalent work experience preferred.
• 1 to 2 years of claims experience in a self-funded environment.
• Thorough knowledge of Stop Loss terminologies, concepts, and catastrophic claim handling.
• Ability to interpret Stop Loss contracts and Client summary Plan Descriptions (SPD).
• Stop loss filing experience preferred.
• Accounting or Finance background a plus.
• Proficient with Microsoft Office Suite, specifically with Microsoft Excel.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Demonstrated elevated level of organizational skills and superior attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Demonstrated ability in developing and maintaining positive relationships with team members, internal departments, various brokers, reinsurance carriers, and clients.

Work Environment

This is a standard desk role requiring extended sitting and computer work. The company offers a remote-friendly culture with flexibility and the comfort of working from home. A reliable internet connection with speeds of at least 100Mbps download/25Mbps upload is required.

Benefits

Allied offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.