Stop Loss Claims Auditor

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

📋 Description

• Analyze Specific Stop Loss claims.

• Identify and isolate data pertinent to a specific claim submission.

• Validate which expenses qualify under the stop loss policy and summary plan description.

• Accurately apply deductibles, coinsurances, and aggregate specific deductibles and lasers.

• Provide customer service to MGU partners and their associated TPAs.

• Conduct timely follow-ups on all pended claims.

• Contribute innovative ideas and assist in the implementation of new processes.

⛳️ Requirements

• Must possess proficiency in Excel, including knowledge of basic formulas, sorting techniques, and Pivot Tables.

• Minimum of 2 years of experience in claims handling, specifically with first dollar medical claims, specific and/or aggregate claims, HMO reinsurance, and/or provider excess claims.

• Prior experience with industry repricing methodologies such as PPO, Wrap Networks, Reference Based Pricing, etc.

• Demonstrated proficiency in Microsoft Office, including Microsoft Outlook.

• Proven strong analytical and critical thinking skills with a detail-oriented focus.

• Excellent written and verbal communication skills.

• Ability to work independently with minimal supervision.

• Preferred: Previous experience auditing managed care or specific/aggregate stop loss claims.

• Preferred: A track record of successful Process Improvement initiatives.

🏝️ Benefits

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

• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement.

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

• Paid Time Off.

• Holidays.

• Preferred Partner Discounts.