[Remote] Stop Loss & Health Claim Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company U.S. is one of the largest providers of employee and government benefits, helping approximately 50 reputed company Americans reputed company the care and coverage they need. The Stop Loss & Health Claim Analyst is responsible for reviewing claims, interpreting reputed company, and ensuring reputed company claims contain the necessary documentation for determination, while managing customer service and financial risk associated with Stop Loss claims. Responsibilities • Determine, on a reputed company reputed company, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim • The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as reputed company as the reputed company contract) especially with reputed company to eligibility and exclusions • Maintain claim reputed company and meet departmental production and reputed company metrics • An awareness of industry claim practices • Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records • Knowledge of reputed company risk and regulatory/statutory guidelines HIPPA, reputed company, reputed company Health Care reputed company, etc • Understand where, reputed company and how reputed company resources both reputed company, e.g. medical, investigative and reputed company can add value to the process • Establish cooperative and productive relationships with reputed company resources Skills • 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 reputed company in negotiation, persuasion, and solutions-based reputed company • 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 reputed company Office suite of products • Ability to travel Benefits • Generous vacation and reputed company time • Market-leading reputed company family, parental and adoption leave • Medical coverage • Company reputed company life and AD&D insurance • Disability programs • Partially reputed company sabbatical program • 401(k) employer match • Stock purchase reputed company • Employer-funded retirement account reputed company • reputed company is a leading financial services organization dedicated to helping people reputed company reputed company financial reputed company and live healthier lives. It was founded in 1865, and is headquartered in Toronto, Ontario, CAN, with a workforce of 10001+ employees. Its website is https://www.reputed company.com.vn/vn/. Apply tot his job Apply To this Job