Clinical Operations Specialist

Job Summary

A company is looking for a Clinical Operations Specialist, Medical Stop Loss - Remote.

Key Responsibilities

• Receive, track, analyze claims data and clinical information for medical underwriting and cost containment processes
• Set up referral and review documents accurately using various platforms and systems
• Generate reports for management to monitor department activity and performance

Required Qualifications

• Bachelor's degree from an accredited college or university required
• Employer Stop Loss Claims/notification experience preferred
• Advanced PC skills including Excel, Word, and SharePoint/OneDrive
• Experience with medical terminology and claim coding preferred
• Ability to prioritize and manage workload effectively