Senior Stop Loss Claims Analyst
Highmark Health
full-time
Posted on:
Location Type: Hybrid
Location: Louisiana, Maryland, North Carolina, Pennsylvania, Washington • 🇺🇸 United States
Visit company websiteSalary
💰 $23 - $35 per hour
Job Level
Senior
About the role
- Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed
- Provides counseling to clients and assists with client service programs
- Evaluates various claims submitted by Third Party Administrators (TPAs) for compliance with underlying policy provisions, federal and state regulatory guidelines, and industry standards
- Monitors, reviews and analyzes various complex potential claims
- Determines whether to pend or adjudicate claims following organizational policies and procedures
- Completes pended claim letters for incomplete, invalid, or missing claim information
- Identifies potential discrepancies in claim submissions
- Assists leadership with performing client performance evaluations
- Maintains accurate claim records
Requirements
- High School Diploma/GED
- 5 years of relevant, progressive experience in health insurance claims
- 3 years of prior experience processing 1st dollar health insurance claims
- 3 years of experience with medical terminology
- 3 years of experience in a Stop Loss Claims Analyst role (preferred)
- Ability to communicate concise accurate information effectively
- Organizational skills
- Ability to manage time effectively
- Ability to work independently
- Problem Solving and analytical skills
Benefits
- Health insurance
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
health insurance claims processingStop Loss claims analysismedical terminologyclaims evaluationcompliance assessmentclaim record maintenancediscrepancy identificationadjudication of claimsclient performance evaluationclaim letter completion
Soft skills
communicationorganizational skillstime managementindependenceproblem solvinganalytical skills
Certifications
High School DiplomaGED