Crumdale Specialty ยท 10 hours ago
Stop Loss Auditor
Paoli, PA
Full-time
Onsite
Senior Level
5+ years expCrumdale Specialty is a diversified insurance firm providing custom solutions to businesses nationwide. The Senior Stop Loss Analyst oversees stop loss claims within Health Plan Services, requiring strong analytical skills and effective coordination with internal teams and external partners for accurate claim processing and compliance.
AnalyticsConsultingInsuranceRisk Management
Responsibilities
Coordinate internally as well as externally with TPAs and claim audit vendors on claim questions or issues
Identify, track, escalate and resolve pending claims
Work with carrier partners to properly document certain approvals and facilitate the timely carrier review of claims when appropriate
Identify when full year-end aggregate audits are needed
Coordinate claim submission to external aggregate audit vendor
Review audit reports, research issues identified, and recommend next steps to close out
Ensure Rx rebates are applied and reported
Track Level-Funded group activity
Utilize database to identify groups with funding needs, analyze funding and claim activity, including in-process claims, to determine action needed
Verify TPA funding reporting matches our funding activity; work with TPA to reconcile discrepancies
Compile reporting and submit to carriers as necessary
May be assigned by the manager as needed
Qualification
Required
5+ years of Stop Loss claims auditing experience
Strong understanding of stop loss insurance principles and in-depth knowledge of medical insurance claims
Excellent communication and interpersonal skills, with the ability to collaborate effectively across departments and with external partners
Strong analytical skills with proficiency in data analysis and interpretation
Detail-oriented mindset with a focus on accuracy and compliance
Ability to prioritize tasks and manage multiple responsibilities in a fast-paced environment
Proficiency in Microsoft Office Suite and database management tools
Ability to handle sensitive or confidential information and maintain confidentiality at all times
Preferred
Knowledge of relevant regulations and industry standards pertaining to insurance and claims management
Benefits
Medical
Telemedicine
Dental
Vision
Life, AD&D, Disability
401(k)
Flexible Time-off
Company
Crumdale Specialty
Crumdale Specialty is a diversified insurance firm providing custom, self-funded healthcare solutions to a bespoke set of brokers, consultants, and agents nationwide.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Matthew S. Naylor
Chief Executive Officer
Company data provided by crunchbase