Epic Health Solutions ยท 2 months ago
Specific Stop Loss Specialist
US
Full-time
Onsite
Mid Level
3+ years expVUMI Canada, Inc. is seeking a Specific Stop Loss Specialist who will manage Specific Reimbursements and Advance Funding processes for self-funded and level-funded clients. The role involves claims processing, conducting research, and ensuring accurate coordination and filing.
Health CareMedicalWellness
Responsibilities
Coordinate and file Specific Reimbursements and Advance Funding requests
Conduct detailed research using claims data to support reimbursement processes and payments
Documentation of authorizations and/or denials by the stop loss carriers
Maintain professional communication with internal teams, vendors and clients
Operate independently while meeting deadlines and compliance standards
Manage and track the received, pended and completed claim files
Document escalations and/or authorizations for release of claim payments
Monitor claims email box for large dollar claims that will affect Stop Loss
Assist with other administrative tasks as needed
Qualification
Required
Intermediate level computer skills, including Microsoft Word, Excel, and Outlook
A high school diploma or GED certificate
At least 3 years' experience as a claims examiner processing first dollar medical claims
Stop loss insurance knowledge a plus
Overall knowledge of Healthcare industry
Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
Strong communication and organizational skills
Excellent written and verbal communication skills
Company
Epic Health Solutions
Epic Health Solutions provides network solutions, healthcare management, and medical assistance for international clients.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase