Stop Loss Claim Specialist

Job Description

Job Description

Stop Loss Claim Specialist

Pay: $19.00 - $21.00 per hour

About the Opportunity

Adecco is seeking a detail-oriented and analytical Stop Loss Claims Specialist to support a growing insurance administration team in Fresno, CA. The ideal candidate will have experience reviewing and processing health insurance claims, interpreting policy provisions, and working with medical coding and claims documentation.

This is an excellent opportunity for someone looking to grow their career in the healthcare insurance industry while working with a collaborative and professional team.

Key Responsibilities

• Review and process stop loss claims for accuracy, completeness, and eligibility.

• Analyze medical documentation and claims information to ensure proper claim determination.

• Verify policy coverage, benefits, and claim requirements.

• Research and resolve claim discrepancies while maintaining compliance standards.

• Enter and maintain accurate claim records within internal systems.

• Communicate effectively with internal departments, carriers, and other stakeholders regarding claim status and requirements.

• Assist with claim audits, reporting, and ongoing process improvements.

Required Qualifications

• Previous experience in health insurance, medical claims, benefits administration, or claims processing.

• Knowledge of medical terminology and medical documentation.

• Experience with Stop Loss claims preferred.

• Understanding of CPT, HCPCS, and ICD-10/ICD-9 coding .

• Strong attention to detail and organizational skills.

• Proficiency with Microsoft Office and claims management systems.

• Ability to manage multiple priorities in a fast-paced environment.

Preferred Qualifications

• Experience reviewing medical records and claim adjudication.

• Background in insurance verification or healthcare administration.

• Knowledge of commercial health insurance plans and regulatory requirements.

• Customer service experience within a healthcare or insurance environment.

Skills for Success

• Analytical and problem-solving abilities

• Strong written and verbal communication

• Time management and prioritization

• Accuracy and attention to detail

• Ability to maintain confidentiality when handling protected information

• Collaborative team mindset

Pay Details: $19.00 to $21.00 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.