Stop Loss Claims Examiner

Job Summary

Reviewing and processing excess loss claims, the full-time Stop Loss Claims Examiner will analyze policy provisions, maintain documentation, and ensure accurate reimbursements while working in a remote environment.

Key responsibilities

• Review and decide on reimbursement of excess loss claims, ensuring compliance with policy terms and maintaining high accuracy in claim handling
• Maintain current pending claims through consistent follow-up and documentation, interacting with TPA contacts for necessary information
• Identify potential claims for referral to Medical Risk Consultants and alert internal teams about possible catastrophic claims risks

Required qualifications

• High school diploma or equivalent work experience; college degree preferred
• 1-3 years of relevant experience in claims examination or auditing
• Familiarity with medical procedure terminology
• Experience with audit and bill review is a plus
• Proficiency with Excel is required