Stop Loss Aggregate Analyst

This is a fully remote position, open to applicants in Idaho, +2 more states.

📋 Description

• Prepare, update, and submit stop loss filing packages, which include initial, subsequent, and year-end filings as necessary.

• Monitor claim activity and ensure follow-up until resolution with stop loss carriers and other stakeholders to guarantee accurate and timely reimbursements.

• Analyze reports and reimbursement activity trends for assigned employer groups and clients.

• Assist in investigating and reconciling discrepancies between the amounts requested for reimbursement and those returned by stop loss carriers.

• Act as a client advocate by maximizing eligible reimbursements under applicable stop loss policies.

• Evaluate claim documentation for thoroughness, precision, and compliance with policy provisions and filing requirements.

• Investigate and resolve cases needing further analysis, documentation, or clarification.

• Engage with internal and external stakeholders to gather information, address issues, and support prompt resolution of filings.

• Collaborate with cross-functional teams, including underwriting, finance, eligibility, and client support, to expedite filing resolutions.

• Keep precise records, logs, and supporting documentation related to assigned stop loss filings and reimbursements.

• Appropriately escalate complex issues or delays and assist in process improvement initiatives when trends or gaps are detected.

⛳️ Requirements

• A minimum of 2 years of experience in healthcare claims processing or a related health insurance field.

• At least 2 years of experience using Microsoft Office applications, especially Excel.

• Excellent analytical, problem-solving, and organizational abilities.

• Strong verbal and written communication skills.

• Capacity to work both independently and collaboratively within a matrixed team in a fast-paced setting.

• Exceptional attention to detail with the ability to manage multiple priorities and meet deadlines.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources, subject to eligibility.