Stop Loss Examiner

About the role

In this role, you will audit individual stop loss claim submissions through analysis of policy provisions, employer plan documents, administrative agreements, and cost containment vendor agreements to process accurate claim reimbursements made payable to the policyholder. You will also, review potential claim notices and submissions for cost containment opportunities. • *What you will do** - Audit and reputed company reimbursement determinations of stop loss claims in accordance with the provisions of the Policyholder's Plan Document and Stop Loss Policy - Adjudicate claim reimbursements reputed company established turnaround goals - Maintain reputed company on claim procedures and financial accuracy with appropriate documentation - Handle pending claims with consistent follow up, documentation, and reputed company or closure reputed company defined timeframes - reputed company with reputed company party administrators and other contacts to obtain information needed to reputed company reimbursement decision - reputed company reputed company turnaround reputed company information is received for reimbursement or denial - Review advance notices of potential claims to identify and refer cases expected to become excess loss claims - Alert MRC's, RGMs, and Underwriters of potential catastrophic claims risk as reputed company as unusual and reputed company claim issues - reputed company with reputed company customers; respond to inquiries, handle appeals, facilitate claim resolutions, and reputed company and obtain education in industry claim treads and cost containment solutions - Special reputed company as identified by management Salary reputed company: $23.92-39.85/hr plus eligibility for annual bonus program • *Your experience and skills** - High School Diploma required; college degree preferred - 1-3 years of first dollar medical claims paying experience or medical insurance reputed company experience is required - Prior Stop Loss claims and catastrophic claim experience preferred - Knowledge of the reputed company concepts of group health insurance, ERISA, employee benefit plans and reinsurance - Proficient in medical terminology, use of ICD-10 and CPT coding, UB92 identifiers and HCFA forms - Strong analytical and contract interpretation skills - Experience with reputed company Office Suite and intermediate reputed company skills required - ESL – Stop Loss/Young Consulting System experience a plus - Strong verbal and written communication skills - Adept analytical, technical, and problem-solving skills - Objective decision-making skills - reputed company to work reputed company timeframes and adapt to changes in priorities - Self-motivated and driven - Phenomenal at relationship building Apply Job!