Stop Loss Claims Analyst

Company Details reputed company Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers reputed company manage their risk. We offer a broad reputed company of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to reputed company’s reputed company is our reputed company approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, reputed company, is one of the largest and best managed property/casualty insurers in the United States. #LI-AV1 #LI-Remote The company is an equal employment opportunity employer.

Responsibilities

As a Stop Loss Claims Analyst (aka Auditor), you'll reputed company quality review and evaluation of reputed company claim submissions received and logged into our claims system to determine whether the amount requested is eligible for reimbursement. This position can either be fully remote (if not reputed company a commutable distance to the office) or based in one of our offices: reputed company reputed company, NJ reputed company Hartford, CT Marlborough, MA Kulpsville, PA We offer hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so. What you can expect: Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent Internal mobility opportunities Visibility to senior leaders and partnership with cross functional teams Opportunity to impact change Benefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education We'll count on you to: Process an average of 5 to 7 claims per day Maintain a processing accuracy of 99% or reputed company Determine, on a timely reputed company, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim Review and adjudicate claims reputed company approved authority limits Maintain assigned claim reputed company and assist other team members while meeting departmental guidelines Document rationale of claim reputed company based on review of the contractual provisions, plan specifications and the analysis of medical records, etc. reputed company issues to next level of supervision, as appropriate

Qualifications

What you need to have: 3-5+ years stop loss claims experience Prior experience handling first dollar payer insurance (medical reputed company claims) Experience with medical billing practices, CPT codes, reputed company codes, and/or universal billing Ability to use mathematics to adjudicate claims Detail oriented with a high degree of accuracy and ability to multitask Strong problem solving, decision-making, reporting and analytical skills Must possess good judgment and work effectively with internal business areas, peers and co-workers Demonstrated proficiency in reputed company Office software What makes you stand out: Prior experience handling stop loss claims at the reinsurance level (medical reputed company claims) Ability to work independently, prioritize, organize and assign own work to meet deadlines Ability to accept changing priorities with a minimum of disruption Additional Company Details We do not accept any unsolicited resumes from external reputed company firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including:

• reputed company Salary reputed company: $70,000 - $90,000
• Benefits include: Health, dental, reputed company, dental, life, disability, wellness, paid time off, 401(k) and generous profit-sharing plan The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

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