Key skills
Communication
About this role
Role Overview
- Conduct reconciliations for individual stop loss claim reimbursements
- Handle escheatment, offsets within claims system, various special projects
- Track, calculate and pursue overpayments identified within Stop Loss department
- Research files and understand claims, type of overpayment, and resolution options
- Follow up on overpayment requests and provide detailed descriptions of circumstances
- Conduct discussions with internal claims analysts
- Provide monthly recovery reports (analysis, trending, actions, status)
- Receive escheatment report and investigate customer data for banking
Requirements
- Ability to work with a diverse range of people
- Requires expert level understanding of the Stop Loss claims process or Medical Claims regarding overpayments
- 5+ years understanding of first dollar stop loss claims or medical claims
- Prior experience in medical or Stop Loss claim adjudication
- Proficient in Excel with advanced skills (complex formula construction, pivot table manipulation, Vlookup, queries creation)
- Adept knowledge in navigating and utilizing SharePoint (document management, tracker creation, basic site administration)
- Strong understanding of business and relationship building with external customers
- Highly skilled verbal and written communication skills
Benefits
- Excellent benefits and wellness programs to support mental, physical and financial well-being
- Generous vacation and sick time
- Market-leading paid family, parental and adoption leave
- Partially-paid sabbatical program
- Medical plans
- Company paid life and AD&D insurance
- Disability programs
- Retirement and Stock Purchase programs
- 401(k) plan with employer-paid match
- Employer-funded retirement account
- Flexible work environment with a friendly, caring, collaborative and inclusive culture