Stop Loss Claims Specialist
Health in Tech (HIT) is reimagining and simplifying the way self-funded health plans are designed, priced and packaged for small to mid-sized companies. We are a fast-growing company combining the expertise of software developers, reinsurance specialists, insurance administrators and health-care providers to challenge the high-cost of health insurance for businesses and dramatically simplify the buying process.
Summary
The Stop Loss Claims Specialist is responsible for the reconciliation of information/documentation from third-party administrators, and the adjudication and reconciliation of Aggregate Stop Loss Claims. Duties and Responsibilities Include 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. Qualifications for the Stop Loss Claims Specialist include: 4+ years of experience with medical claims processing and adjudication. Experience with third party administration, self-funding, stop loss claims, excess loss claims, and/or reinsurance is preferred. Aggregate claim experience is also preferred. 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 Apply Job!