Stop Loss Claims Analyst

Job Summary

Working remotely or onsite in one of several office locations, the full-time Stop Loss Claims Analyst will evaluate claim submissions to determine eligibility for reimbursement, ensuring a high level of accuracy and compliance with contractual provisions.

Key responsibilities

• Process an average of 5 to 7 claims per day while maintaining a processing accuracy of 99% or better
• Review and adjudicate claims based on medical facts and contractual specifications, documenting rationale for decisions
• Collaborate with team members and escalate issues to supervision as necessary, adhering to departmental guidelines

Required qualifications

• 3-5+ years of stop loss claims experience
• Prior experience with first dollar payer insurance and medical healthcare claims
• Knowledge of medical billing practices, CPT codes, and revenue codes
• Strong mathematical skills for claim adjudication
• Proficiency in Microsoft Office software