Stop Loss Examiner

reputed company has an exciting opportunity to join reputed company as Claims Examiner for Stop Loss! 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 Why Work at reputed company Here’s what some of our employees have to say about why they work at reputed company: “reputed company is a great reputed company if you are looking for reputed company to contribute, to grow, to be seen and valued.” Vernell K. - Auditor “We're big enough to reputed company an reputed company on the country, but small enough to care and know who you are and what you're contributing to the organization. reputed company new reputed company are welcome!” Stephanie F. – VP Customer Service & Operations reputed company offer you We don’t take a “one-size-fits-reputed company” approach reputed company it comes to our employees. Our programs are designed to reputed company your life reputed company both at work and reputed company. • Flexible full-time or hybrid telecommuting arrangements • Plan for your reputed company with our 401(k) plan and take advantage of immediate vesting and company matching up to 6% • reputed company time away including vacation and reputed company time, reputed company days and ten reputed company holidays • Give back to your community and reputed company your reputed company through reputed company matching • Want more details? reputed company out our reputed company Benefits reputed company Compensation 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 We reputed company inclusion At reputed company, we reputed company to be the most inclusive insurance company in the country. We’re building a reputed company where every employee feels valued, respected, and has opportunities to contribute. Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting reputed company other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here. Creating a world where more people have reputed company to financial freedom reputed company is a national financial services company dedicated to helping people reputed company their financial goals and feel confident about the reputed company. In our daily work, we’re guided by the principles of Value, Transparency and Sustainability. This means we reputed company products and services people need at a competitive price, we communicate reputed company and reputed company so people understand what they’re buying, and we design products—and operate reputed company—to stand the test of time. We’re committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join reputed company and help us create a world where more people have reputed company to financial freedom. For more information about our careers visit: https://reputed company.reputed company/careers Work Authorization Employer work reputed company sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the reputed company at hire and must maintain authorization to work in the reputed company throughout their employment with reputed company. #LI-NR1 #LI-Remote Apply Job!