Stop Loss Claims Auditor

Stop Loss Claims Analyst

As a Stop Loss Claims Analyst (aka Auditor), you'll perform quality review and evaluation of all 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 within a commutable distance to the office) or based in one of our offices:

• Hamilton Square, NJ
• West 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 better
• Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
• Review and adjudicate claims within approved authority limits
• Maintain assigned claim block and assist other team members while meeting departmental guidelines
• Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.
• Elevate issues to next level of supervision, as appropriate

What you need to have:

• 3-5+ years stop loss claims experience
• Prior experience handling first dollar payer insurance (medical healthcare claims)
• Experience with medical billing practices, CPT codes, revenue 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 Microsoft Office software

What makes you stand out:

• Prior experience handling stop loss claims at the reinsurance level (medical healthcare 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 recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: Base Salary Range: $70,000 - $90,000 Benefits include: Health, dental, vision, 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.

Sponsorship Details: Sponsorship not Offered for this Role