Claims Examiner – Medical Stop Loss

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

📋 Description

• Review all claim submissions to ensure they are accurate, complete, and compliant with Plan Documents, SPDs, and Policies within the established authority levels.

• Handle external requests for information and ensure timely follow-up.

• Communicate decisions regarding claim payments and denials.

• Confirm necessary disclosures when applicable.

• Calculate and manage reserves as required.

• Support aggregate accommodation activities and submissions of aggregate claims.

• Keep the team and management informed about assigned responsibilities through consistent reporting and communication.

• Assist in refining internal claim procedures and suggest improvements to management.

• Perform additional duties as assigned.

⛳️ Requirements

• Minimum of 3 years of experience in medical stop loss claims is necessary.

• A Bachelor’s degree or equivalent experience is required.

• Proficient in the Microsoft Office suite.

• Ability to learn new software programs quickly.

• Strong capability to build rapport with all stakeholders.

• Dedicated to providing exceptional customer service and satisfaction.

• Committed to exploring and assisting in the implementation of new processes to enhance effectiveness and meet organizational goals.

• Exceptional attention to detail and accuracy is essential.

• Ability to handle multiple priorities in a fast-paced setting.

• Excellent written and verbal communication skills are required.

🏝️ Benefits

• Competitive compensation package.

• Generous 401K employer matching.

• Employee Stock Purchase plan with employer matching.

• Generous Paid Time Off.

• Comprehensive health, dental, and vision benefits.

• Wellness programs that focus on physical, mental, and financial well-being.

• Tuition reimbursement opportunities.

• Support for industry-related certifications.

• Professional training provided.

• A dynamic, ambitious, fun, and exciting work environment.

• Matching donation program.

• Opportunities for volunteer work.

• An employee-driven corporate giving program.