Stop Loss Claims Analyst

Job Summary

A company is looking for a Stop Loss Claims Analyst to evaluate claim submissions for reimbursement eligibility.

Key Responsibilities

• Process an average of 5 to 7 claims per day with a 99% accuracy rate
• Determine eligibility of claims by applying contractual provisions to medical facts
• Document claim decisions and elevate issues as necessary

Required Qualifications

• 5+ years of stop loss claims experience
• Prior experience with first dollar payer insurance and medical healthcare claims
• Familiarity with medical billing practices, CPT codes, and revenue codes
• Ability to use mathematics for claim adjudication
• Proficiency in Microsoft Office software