Stop Loss Claims Auditor

Risk Strategies
Full time
Other
United States
Hiring from: Anywhere

Stop Loss Claims Auditor



  • REMOTE

  • United States


Description



  • Risk Strategies, a privately-held National Insurance Brokerage and Risk Management Firm with over 1,900 employees and 100 offices throughout the US, is seeking a collaborative and resilient Stop Loss Claims Auditor.

  • The Stop Loss Claims Auditor will provide Specific Stop Loss claims auditing services for MGU and/or Carrier clients.


Primary Responsibilities and Duties:



  • Analyze Specific Stop Loss claims.

  • Identify and isolate the data that is specific to a particular claim submission.

  • Validate which expenses are eligible under the stop loss policy.

  • Accurately apply all deductibles, coinsurances, aggregating specific deductibles and lasers.

  • Conduct timely follow up on all pended claims.

  • Contribute innovative ideas and assist with the implementation of new processes.


Requirements



  • Must have Excel Proficiency to include knowledge of basic formulae, sorting techniques, PIVOT Tables and VLOOKUP.

  • Minimum 2 years Claims experience with first dollar medical claims, specific and/or aggregate

  • Prior experience with industry repricing methodologies. (PPO, Wrap Networks, Reference Based Pricing etc.)

  • Demonstrated proficiency in Microsoft Office, to include Microsoft Outlook.

  • Demonstrated strong analytical/critical thinking skills; and detailoriented focus.

  • Strong written and verbal communication skills.

  • Ability to work independently with minimal supervision


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