Aggregate Stop Loss Claims Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct an analysis of Aggregate Stop Loss Year End claims, including a High Level Review and Aggregate Accommodation claims.

• Confirm which expenses qualify under the aggregate stop loss agreement.

• Identify and assess eligibility exceptions and claims that are outside the contract.

• Validate funding.

• Execute enrollment evaluations and calculations to ensure the accurate calculated or minimum attachment point is applied.

• Generate audit deliverables, such as the Audit Report for the client, Exhibits, and Non-Exhibits, within the company's designated timeframes.

• Address all appeals from Third Party Administrators (TPAs).

• Offer innovative suggestions and support the implementation of new processes.

⛳️ Requirements

• Proficiency in Excel, including knowledge of Basic or Advanced Formulas and PIVOT Tables.

• A minimum of 3-4 years of experience with self-funding, as well as specific and/or aggregate claims; or reinsurance claims.

• Proven expertise in Microsoft Office, encompassing Microsoft Word and Outlook.

• Strong analytical and critical thinking abilities.

• Excellent organizational skills, time management capabilities, and a detail-oriented mindset.

• Strong written and verbal communication skills.

• Ability to work independently with minimal oversight.

• Occasional travel may be required.

• Preferred: Previous experience with self-funding and the stop loss product.

• Preferred: Prior experience in reviewing and/or auditing aggregate stop loss claims.

• Preferred: A background of successful Process Improvement initiatives.

🏝️ Benefits

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance.

• Financial Benefits: Employee Stock Purchase Plan (ESPP); 401k; Student Loan Assistance; Tuition Reimbursement.

• Mental Health & Wellness: Complimentary Mental Health & Enhanced Advocacy Services.

• Paid Time Off.

• Holidays.

• Preferred Partner Discounts.