Stop Loss Claims Auditor

Remote - United States

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Risk Strategies
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Posted 4 weeks ago

Risk Strategies, a privately-held National Insurance Brokerage and Risk Management Firm with over 1,900 employees and 100 offices throughout the US, is seeking a collaborative and resilient Stop Loss Claims Auditor. The Stop Loss Claims Auditor will provide Specific Stop Loss claims auditing services for MGU and/or Carrier clients.

Primary Responsibilities and Duties:

  • Analyze Specific Stop Loss claims.
  • Identify and isolate the data that is specific to a particular claim submission.
  • Validate which expenses are eligible under the stop loss policy.
  • Accurately apply all deductibles, coinsurances, aggregating specific deductibles and lasers.
  • Conduct timely follow up on all pended claims.
  • Contribute innovative ideas and assist with the implementation of new processes.


  • Must have Excel Proficiency to include knowledge of basic formulae, sorting techniques, PIVOT Tables and VLOOKUP.
  • Minimum 2 years Claims experience with first dollar medical claims, specific and/or aggregate
  • Prior experience with industry repricing methodologies. (PPO, Wrap Networks, Reference Based Pricing etc.).
  • Demonstrated proficiency in Microsoft Office, to include Microsoft Outlook.
  • Demonstrated strong analytical/critical thinking skills; and detail‐oriented focus.
  • Strong written and verbal communication skills.
  • Ability to work independently with minimal supervision
Job tags: Excel Risk management