Allied Benefit Systems

Stop Loss Claims Specialist I

Allied Benefit Systems

full-time

Posted on:

Location Type: Remote

Location: Remote • Illinois • 🇺🇸 United States

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Salary

💰 $23 - $24 per hour

Job Level

JuniorMid-Level

About the role

  • 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

Requirements

  • High School diploma or equivalent required
  • 1-2 years of claims experience in a self-funded environment
  • Thorough knowledge of Stop Loss terminologies, concepts, and catastrophic claim handling
  • Ability to interpret Stop Loss contracts and Client summary Plan Descriptions (SPD)
  • Proficient with Microsoft Office Suite, specifically with Microsoft Excel
  • Strong analytical and problem-solving skills
  • Excellent verbal and written communication skills
  • Demonstrated elevated level of organizational skills and superior attention to detail
  • Excellent time management skills with a proven ability to meet deadlines
  • Demonstrated ability in developing and maintaining positive relationships with team members, internal departments, various brokers, reinsurance carriers, and clients
Benefits
  • Medical
  • Dental
  • Vision
  • Life & Disability Insurance
  • Generous Paid Time Off
  • Tuition Reimbursement
  • EAP
  • Technology Stipend

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
claims experiencestop loss claimsreimbursement processingclaim reportingcatastrophic claim handlingStop Loss contract interpretationClient summary Plan Descriptions (SPD) interpretationanalytical skillsproblem-solving skillstime management
Soft skills
verbal communicationwritten communicationorganizational skillsattention to detailrelationship buildingteam collaborationdeadline management