Stop Loss Claims Specialist

A company is looking for a Stop Loss Claims Specialist. Key Responsibilities Review Aggregate Claim Reports to determine refunds due to Policyholders and assist in subrogation matters Adjudicate Monthly Aggregate Accommodation Requests in accordance with Stop Loss Policy and Plan Document Provisions Follow up with Third Party Administrators and Policyholders regarding pending claim information/documentation Required Qualifications 4+ years of experience in medical claims processing and adjudication Experience with third party administration, self-funding, stop loss claims, and excess loss claims Knowledge of CPT, ICD-10, and HCPCS codes Strong analytical skills and critical decision-making abilities Proficiency in Microsoft Office applications, particularly Outlook, Excel, and Word

Mar 22, 2025 - 21:59

A company is looking for a Stop Loss Claims Specialist. Key Responsibilities Review Aggregate Claim Reports to determine refunds due to Policyholders and assist in subrogation matters Adjudicate Monthly Aggregate Accommodation Requests in accordance with Stop Loss Policy and Plan Document Provisions Follow up with Third Party Administrators and Policyholders regarding pending claim information/documentation Required Qualifications 4+ years of experience in medical claims processing and adjudication Experience with third party administration, self-funding, stop loss claims, and excess loss claims Knowledge of CPT, ICD-10, and HCPCS codes Strong analytical skills and critical decision-making abilities Proficiency in Microsoft Office applications, particularly Outlook, Excel, and Word