Senior Stop Loss Claims Analyst - Remote

Overview

The Senior Stop Loss Claims Analyst is responsible for reviewing, evaluating, and processing Stop Loss claims, while building positive client relationships and ensuring compliance with regulatory guidelines.

In Short

• Process daily incoming Stop Loss claims.
• Evaluate claims for compliance with policy provisions and regulations.
• Monitor and analyze complex claims to control losses.
• Finalize and adjudicate claims up to a predetermined dollar threshold.
• Assist in client service programs and maintain accurate claim records.
• Identify discrepancies and involve the Special Investigation Unit as necessary.
• Provide counseling and support services to clients.
• Assist leadership with client performance evaluations.
• Train and educate internal staff on claims processes.
• Ensure compliance with HIPAA and company policies.

Requirements

• High School Diploma/GED required; Bachelor’s degree preferred.
• 5 years of relevant experience in health insurance claims.
• 3 years of experience processing 1st dollar health insurance claims.
• 3 years of experience with medical terminology.
• 3 years of experience in a Stop Loss Claims Analyst role preferred.
• Strong communication and organizational skills.
• Ability to work independently and manage time effectively.
• Problem-solving and analytical skills required.

Benefits

• Flexible working arrangements.
• Opportunities for growth and development.
• Collaborative work environment.
• Comprehensive health benefits.
• Support for professional education.