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Stop Loss Claims Specialist I – Aggregate
Allied Benefit SystemsStop Loss Claim Specialist managing medical stop loss claims at Allied Benefit Systems. Preparing and filing claims and ensuring timely reimbursements from various stop loss carriers.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in preparing and filing medical stop loss claims, including appeals and documentation management. Proficient in analyzing claims data and maintaining effective communication with internal departments and external carriers.
Highest-signal resume keywords
Claims ExperienceStop Loss Terminology KnowledgeMicrosoft Excel ProficiencyAnalytical SkillsTime Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims FilingStop Loss Claims HandlingDocumentation ManagementData AnalysisReimbursement Processing
Soft Skills
Communication SkillsOrganizational SkillsProblem SolvingRelationship ManagementAttention to Detail
Tools & Technologies
Microsoft Office Suite
Industry Keywords
Self Funded EnvironmentStop Loss ContractsClient Summary Plan DescriptionsAggregate AccommodationCatastrophic Claim Handling
About the role
Key responsibilities & impact- Prepare and file medical stop loss claims for reimbursement with stop loss carriers for aggregate coverage
- Follow up with the various carriers to ensure reimbursements are received in time and in full
- Appeals of denied and reduced claim reimbursements
- Retain the appropriate documentation needed to support the reimbursement request
- Compile and submit claim reports and the necessary documentation to file a stop loss claim
- Frequently monitor the 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 per contract stipulations
- Audit the aggregate positions, tracking the funding balance and updated reporting monthly
- Prepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity
Requirements
What you’ll need- High School diploma or equivalent required
- Some college or equivalent work experience preferred
- 1 to 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)
- Stop loss filing experience preferred
- Accounting or Finance background a plus
- Proficient with Microsoft Office Suite, specifically with Microsoft Excel
- Strong analytical and problem solving skills
- Excellent verbal and written communication skills
- 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
Comp & perks- Medical
- Dental
- Vision
- Life and Disability Insurance
- Generous Paid Time Off
- Tuition Reimbursement
- EAP
- Technology Stipend