Stop Loss & Health Claim Analyst

Role Overview

• responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination
• responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims
• applying the appropriate contractual provisions
• plan specifications of the underlying plan document
• professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim
• accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources

Requirements

• Bachelor's degree preferred
• A minimum of three to five years’ experience processing first dollar medical claims or stop loss claim processing
• Demonstrated ability to work as part of a cohesive team
• Strong written and verbal communication skills
• Knowledge of Stop Loss Claims and Stop Loss industry preferred
• Demonstrated success in negotiation, persuasion, and solutions-based underwriting
• Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
• Overall knowledge of health care industry
• Proficiency using the Microsoft Office suite of products
• Ability to travel

Benefits

• generous vacation and sick time
• market-leading paid family, parental and adoption leave
• medical coverage
• company paid life and AD&D insurance
• disability programs
• partially paid sabbatical program
• 401(k) employer match
• stock purchase options
• employer-funded retirement account
• flexible, inclusive and collaborative work environment that supports career growth