Senior Stop Loss Claims Auditor

Job Summary

Auditing and authorizing reimbursement of specific medical stop loss claims, the full-time Senior Stop Loss Claims Auditor will work remotely to mitigate client claims and provide exceptional customer service.

Key responsibilities

• Analyze and adjudicate stop loss claims, authorizing reimbursement checks within pre-set limits
• Initiate claims investigations, interpret plan language, and identify subrogation opportunities
• Communicate effectively with carriers and vendors, providing comprehensive claims service for inquiries

Required qualifications

• Associate's degree or equivalent work experience (2 years of job-related experience)
• 6 years of managed care or reinsurance claims experience
• Experience analyzing laws, regulations, and contract language
• Ability to handle confidential and sensitive information
• Experience in investigating claims and proposing adjustments or refunds