Roundstone ยท 1 day ago
Healthcare Claims Adjuster- Stop Loss
Rocky River, OH
Full-time
Hybrid
Mid Level
$60K/yr - $66K/yr
3+ years expRoundstone is an innovative insurance company focused on helping employers save on healthcare benefits. The Medical Stop Loss Adjuster will evaluate and process stop loss claims, ensuring accurate and timely payments while maintaining high standards of accuracy in a fast-paced environment.
Financial ServicesHealth CareHealth InsuranceInsuranceRisk Management
Responsibilities
Review and audit claims submissions within authority level for accuracy and completeness and determine appropriate reimbursement
Timely process claims in an accurate manner, communicate with third-party administrators, and ensure proper cost containment
Manage inventory of pended claims according to department metrics
Maintain appropriate reserve records on claims
Actively participate in team meetings and training
Qualification
Required
Knowledge of Health Care services, policies, procedures and systems
3+ years of experience with intake of Medical, Dental, Vision claims
Certified in Medical Terminology I, II and ICD9/10 knowledge
Precise attention to detail
Excellent verbal communication, collaboration, and written skills
Strong organizational and time management skills; handles multiple workstreams with deadlines simultaneously
Proficiency in Microsoft Office (Word, Excel)
Proficiency in claims administration systems such as Javelina, ESL or similar
Benefits
Medical, dental and vision benefits
Annual bonus
Parental Leave
Dependent care 100% match up to max allowable
PTO beginning on Day 1
Tuition reimbursement
Health work/life balance
Hybrid office schedule
401(k) plan with company match
Employee Assistance Program
On-site gym with personal trainer access
Life insurance and short term disability insurance
Company
Roundstone
Roundstone is an employee health benefits company that offers health benefits, reinsurance, risk management, and policy administration.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Jonathan McCorkle
Chief Financial Officer
Helen Simmons
Chief Information Officer
Recent News
Newswire
2025-12-04
2025-07-25
Company data provided by crunchbase