Health In Tech · 1 day ago

Stop Loss Claims Specialist

Full-time

Remote

Mid Level

$70K/yr - $70K/yr

4+ years exp

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Responsibilities

Review Aggregate Claim Reports and other related documentation to determine if refunds are due to the Policyholders, along with assist in the pursuit of subrogated matters and assorted types of overpaid claim scenarios, as applicable.

Review and adjudicate Monthly Aggregate Accommodation Requests, taking into consideration all applicable Stop Loss Policy Provisions, Plan Document Provisions, and internal claims processing protocols, within assigned authority limit.

Perform Claim Intake Process, as needed

Regularly follow up with Third Party Administrators ("TPAs") and Policyholders to check status of our requests for information/documentation in pended claim scenarios.

Qualification

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Medical claims processingAdjudicationCPT codingICD-10 codingHCPCS codingThird party administrationSelf-fundingStop loss claimsExcess loss claimsReinsuranceMicrosoft OfficeCustomer service abilities

Required

4+ years of experience with medical claims processing and adjudication.

Knowledge of CPT, ICD-10, and HCPCS codes, along with knowledge of medical claim practices.

Strong analytical skills/abilities, along with having keen critical decision-making and problem-solving skills, are a must.

Highly proficient in Microsoft Office applications, especially Outlook, Excel, and Word.

Excellent verbal and written communication skills, along with sound organizational skills, and effective customer service abilities.

Preferred

Experience with third party administration, self-funding, stop loss claims, excess loss claims, and/or reinsurance is preferred.

Aggregate claim experience is also preferred.

Company

Health In Tech

Health In Tech (HIT) is an innovative insurance technology platform company that offers technical solutions to transform and improve efficiency in the healthcare industry with vertical integration, process simplification, and automation that removes friction and complexities.

Founded in 1964

Stuart, Florida

51-200 employees