Stop Loss Claims Director - Remote

Overview

The Stop Loss Claims Director will adjudicate accident and health medical claims and pharmacy benefits while maintaining strong communication with clients and intermediaries.

In Short

• Full-time home-based position with occasional travel.
• Adjudicate various types of medical claims.
• Maintain client communication for assigned accounts.
• Audit managed care and provider agreements.
• Knowledge of CMS regulations and medical coding.
• Perform peer editing and training.
• Support company values of innovation and teamwork.
• 5+ years of medical claims experience required.
• Strong analytical and detail-oriented skills needed.
• Comprehensive benefits package offered.

Requirements

• 5+ years medical claims experience.
• Ability to work independently and collaboratively.
• Knowledge of claim processing platforms.
• Ability to travel occasionally for off-site audits.
• Excellent written and verbal communication skills.
• Strong skills in Microsoft Office/Word/Excel.

Benefits

• Medical, dental, and vision plans.
• 401k plan with employer matching.
• Discretionary Time Off and Paid Time Off policies.
• Paid holidays.
• Life insurance and disability plans.