Stop Loss Claims Analyst

Job Summary

A company is looking for a Claims Analyst to perform quality review and evaluation of claim submissions for reimbursement eligibility.

Key Responsibilities

• Process an average of 5 to 7 claims per day with a processing accuracy of 99% or better
• Determine claim eligibility by applying appropriate contractual provisions to medical facts
• Document claim decisions and elevate issues to supervision as needed

Required Qualifications

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