Stop Loss Claims Analyst

Job Summary

To support the claims processing team, the full-time Stop Loss Claims Analyst will perform quality reviews of claim submissions, ensuring eligibility for reimbursement while working either fully remote or in-office as part of a hybrid schedule.

Key responsibilities

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

Required qualifications

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