Stop Loss Claims Auditor

Job Summary

Working remotely in a full-time capacity, the Stop Loss Claims Auditor will manage claims examination, auditing, and processing while demonstrating proficient knowledge of Stop Loss processes and procedures.

Key responsibilities

• Audit submitted claims for accuracy and compliance with relevant plans and policies
• Compile and review claims information, including health plans and insurance contracts
• Respond to customer inquiries regarding claims and provide timely support

Required qualifications

• Associate or Bachelor's Degree or a combination of experience and education
• 3-5 years of experience processing first dollar medical claims
• Experience in processing Stop Loss Claims
• Prior experience in self-insured plan management
• Familiarity with legal risks and regulatory guidelines related to HIPAA and the Affordable Care Act