Trainer, Stop Loss Claims

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

📋 Description

• Create a comprehensive training curriculum along with all essential materials and documentation for specific stop loss claims.

• Provide training for newly hired Specific Stop Loss claims auditors and conduct refresher courses for existing auditors.

• Develop objective assessment tools to evaluate trainee progress.

• Assess whether trainees successfully complete their training and are prepared for production work.

• Act as a subject matter expert, offering technical support to designated claims teams.

• Review and analyze Specific Stop Loss claims that are referred by auditors or requested by clients.

• Support over authorization reviews.

• Conduct audits of Specific Stop Loss claims during high-demand periods.

• Identify and implement continuous process improvement opportunities.

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

⛳️ Requirements

• 3–5 years of experience in Specific Stop Loss Claims.

• Previous experience in a Team Lead or Management role within stop loss claims, including quality assurance experience.

• Familiarity with industry repricing methodologies such as PPO, Wrap Networks, and Reference Based Pricing.

• Proven proficiency in Microsoft Office applications, including Microsoft Outlook.

• Strong analytical and critical thinking abilities.

• Detail-oriented approach.

• Excellent written and verbal communication skills.

• Capability to work independently with minimal supervision.

• Previous experience auditing aggregate stop loss claims (preferred).

• A track record of successful Process Improvement initiatives (preferred).

• Prior experience in leading a team or managing processes (preferred).

🏝️ Benefits

• Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance.

• Employee Stock Purchase Plan (ESPP).

• 401k retirement plan.

• Student Loan Assistance.

• Tuition Reimbursement.

• Complimentary Mental Health & Enhanced Advocacy Services.

• Paid Time Off.

• Holidays.

• Discounts from Preferred Partners.