Analyst

• Evaluate large medical and pharmacy claims for stop loss reimbursement eligibility
• Assist in preparation and submission of stop loss claims to carriers, ensuring compliance with contract terms
• Monitor reimbursements and maintain status updates on pending claims
• Collaborate with internal departments (Claims, Care Management, Finance) to gather documentation
• Liaise with stop loss carriers to resolve claim issues and provide necessary support
• Maintain detailed records in accordance with regulatory and HIPAA standards
• Identify process inefficiencies and recommend improvements to optimize claims cycle time

Stop Loss Analyst

Energy Analyst II

Incident Analyst