Allied Benefit Systems

Insurance

• Preparing and filing medical stop loss claims for reimbursement with stop loss carriers
• Following up with carriers to ensure reimbursements are received in time and in full
• Appealing denials and reductions of claim reimbursements
• Retaining appropriate documentation for reimbursement requests
• Compiling and submitting claim reports and necessary documentation
• Monitoring the status of assigned claims and following up with carriers
• Communicating with internal departments to resolve claim issues
• Preparing claim filings upon reconciliation of claim activity
• Managing time to file advanced funding and high dollar claim submissions

Stop Loss Claims Specialist I

• Prepare and file medical stop loss claims for reimbursement
• Follow up with various carriers to ensure reimbursements are received in time and in full
• Handle appeals of denied and reduced claim reimbursements
• Retain appropriate documentation needed to support the reimbursement request
• Compile and submit claim reports and necessary documentation
• Monitor status of claims assigned and follow up with stop loss carriers
• Answer questions and requests from stop loss carriers for additional information
• Communicate with other internal departments to resolve claim issues
• Manage time to file aggregate accommodation, level funded and/or final claim submissions
• Audit aggregate positions, track funding balance, and update reporting monthly
• Prepare year-end and monthly accommodation aggregate claim filings upon reconciliation
• Understand stop loss policy provisions and group plan documentation
• Adapt to new concepts and systems

Stop Loss Claims Specialist I

Stop Loss Claims Specialist I – Aggregate