Stop Loss Claim Auditor

Job Summary

Reviewing and auditing stop loss reimbursement requests, the full-time Stop Loss Claim Auditor will ensure accurate and timely payments while working remotely, focusing on compliance with plan documents and contractual requirements.

Key responsibilities

• Audit stop loss reimbursement requests for accuracy and compliance with established procedures and policies
• Evaluate supporting documentation and perform aggregate claim calculations within delegated authority
• Identify discrepancies and escalate high-risk matters to appropriate internal and external partners

Required qualifications

• 3+ years of experience in healthcare claims, stop loss claims, or medical claim auditing
• Working knowledge of self-funded medical plans and stop loss reimbursement processes
• Strong analytical skills with the ability to perform detailed claim audits accurately
• Proficiency with Microsoft Office applications, particularly Excel and Word
• Ability to handle confidential financial and member information with discretion