Senior Stop Loss Claims Analyst
Highmark Health
full-time
Posted on:
Location Type: Remote
Location: Louisiana • Maryland • United States
Visit company websiteExplore more
Salary
💰 $23 - $36 per hour
Job Level
About the role
- Review, evaluate, and process various Stop Loss claims in accordance with established standards
- Build positive client relationships and provide education
- Analyze client claim losses and current issues
- Follow up on pended claims as per department standards
- Process daily incoming Stop Loss claims
- Evaluate claims for compliance with policy provisions and regulatory guidelines
- Monitor and analyze complex claims and control losses through managed care
- Finalize and adjudicate claims up to a pre-determined dollar threshold
- Complete pended claim letters to TPAs or brokers
- Identify discrepancies in claims submissions
Requirements
- High School Diploma or GED required
- 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
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Stop Loss claims processinghealth insurance claimsmedical terminologyclaims evaluationcompliance analysisclaims adjudicationdiscrepancy identificationmanaged care analysisclaim loss analysispended claims management
Soft Skills
communicationorganizational skillstime managementindependent workproblem solvinganalytical skillsclient relationship buildingeducation provision
Certifications
High School DiplomaGED