Health Claims Stop Loss Auditor

Job Summary

A company is looking for a Health Claims Stop Loss Auditor.

Key Responsibilities:

• Analyze Specific Stop Loss claims
• Validate eligible expenses under the stop loss policy
• Conduct timely follow up on pended claims

Required Qualifications:

• Excel Proficiency with knowledge of basic formulae and PIVOT Tables
• Minimum 2 years of Claims experience
• Prior experience with industry repricing methodologies
• Prior experience auditing managed care or stop loss claims preferred
• History of successful Process Improvement initiatives preferred