Stop Loss Claims Analyst

Job Summary

A company is looking for a Stop Loss & Health Claim Analyst.

Key Responsibilities

• Review claims and determine eligibility by applying contractual provisions to medical facts
• Maintain claim block and meet departmental production and quality metrics
• Prepare written rationale for claim decisions based on contractual provisions and medical record analysis

Required Qualifications

• 3-5 years of experience in processing medical or stop loss claims
• Knowledge of Stop Loss Claims and the Stop Loss industry preferred
• Demonstrated success in negotiation and solutions-based underwriting
• Overall knowledge of the health care industry
• Proficiency in Microsoft Office suite