Stop Loss Claims Analyst

Job Summary

To support a growing team, the full-time Stop Loss Claims Analyst will perform quality reviews and evaluations of claim submissions to determine eligibility for reimbursement, with the option to work fully remote or in one of several office locations.

Key responsibilities

• Process an average of 5 to 7 claims per day while maintaining a processing accuracy of 99% or better
• Determine eligibility of assigned claims by applying appropriate contractual provisions and reviewing medical facts
• Document rationale for claim decisions and elevate issues to supervision as necessary

Required qualifications

• 3-5+ years of stop loss claims experience
• Prior experience handling first dollar payer insurance in medical healthcare claims
• Familiarity with medical billing practices, CPT codes, and revenue codes
• Demonstrated proficiency in Microsoft Office software
• Strong analytical skills with the ability to use mathematics for claims adjudication