Stop Loss Claims Auditor
Remote - United States
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