Senior Stoploss Claim Auditor

Job Summary

Auditing and authorizing reimbursement of medical stop loss claims, the full-time Senior Stoploss Claim Auditor will work remotely to mitigate client claims and provide excellent customer service while analyzing claims, initiating investigations, and maintaining claims system reports.

Key responsibilities:

• Analyze and adjudicate stop loss claims, authorizing reimbursements within authority limits
• Initiate claims investigations and communicate effectively with carriers and vendors
• Generate claims system reports and assist with the training of claims auditors

Required qualifications:

• Associate's degree
• 6 years of managed care or reinsurance claims experience
• Experience analyzing laws, regulations, and contract language
• Ability to handle confidential and sensitive information
• Experience with aggregate claims