Senior Stop Loss Claim Auditor

Job Summary

Senior Stop Loss Claim Auditor is a full-time remote position responsible for auditing and authorizing reimbursement of medical stop loss claims while providing excellent customer service.

Key Responsibilities

• Analyze and adjudicate stop loss claims, requesting reimbursement from carriers and recognizing cost mitigation opportunities
• Initiate claims investigations, interpret plan language, and manage follow-ups on pended claims
• Communicate with carriers, vendors, and management, while generating and maintaining claims system reports

Required Qualifications

• Associate's degree
• 6 years of managed care or reinsurance claims experience
• Ability to analyze laws, regulations, and contract language
• Experience in investigating claims and proposing adjustments and refunds
• Proficient in handling confidential and sensitive information