Job Description:
• Analyze Aggregate Stop Loss Year End claims, High Level Review and Aggregate Accommodation claims
• Validate which expenses are eligible under the aggregate stop loss contract
• Identify and validate eligibility exceptions and extra-contractual claims
• Verify funding
• Perform enrollment evaluation and calculations to ensure the correct calculated or minimum attachment point is applied
• Produce audit deliverables, including Audit Report for client, Exhibits and Non Exhibits, within company-accepted timeframes
• Respond to all appeals from TPAs
• Contribute innovative ideas and assist with implementation of new processes
Requirements:
• Must have Excel Proficiency to include knowledge of Basic or Advanced Formulae and PIVOT Tables
• Minimum 3-4 years of experience with self-funding plus specific and/or aggregate claims; or reinsurance claims
• Demonstrated proficiency in Microsoft Office, to include Microsoft Word and Outlook
• Demonstrated strong analytical/critical thinking skills
• Demonstrated organizational skills, time management skills and detail-oriented focus
• Strong written and verbal communication skills
• Ability to work independently with minimal supervision
• Occasional travel may be needed
• Preferred: Prior experience with self-funding and the stop loss product
• Preferred: Prior experience reviewing and/or auditing aggregate stop loss claims
• Preferred: History of successful Process Improvement initiatives
Benefits:
• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
• Paid Time Off
• Holidays
• Preferred Partner Discounts