Stop Loss Claims Analyst

Job Summary

A company is looking for a Stop Loss Claims Analyst who will adjudicate stop loss claims and ensure adherence to policies and regulations.

Key Responsibilities

• Apply contract benefits accurately and identify incomplete or inappropriate claims
• Make informed decisions on claims, including payment, denial, or requests for additional information
• Audit aggregate claims and manage inventory while documenting claims throughout the adjudication process

Required Qualifications

• High School Diploma or GED
• 5 years of professional claims processing experience or equivalent education and experience
• Strong knowledge of policy and contract terms, including lasering and eligibility
• Advanced knowledge of claim reserving and settlement
• Experience with AI tools and technologies to enhance productivity and decision-making