Job Description:
• Responsible for accurate and timely filing of excess risk medical claims
• Work collaboratively with excess risk companies to answer questions and resolve problems
• Handle initial appeals for reinsurance
• Coordinate all reporting that is supplied by the excess risk companies
• Identify and prepare stop loss claims submissions to obtain client reimbursement
• Communicate with Client Management, Claims, Finance and other impacted departments
• Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount
• Review and process all returned checks resulting from stop loss reimbursements
• Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client
• Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end
Requirements:
• High School Diploma or GED equivalent
• 1 – 2 years of medical claims experience
• Hands-on experience with stop loss (excess risk) claims processing and submissions
• Proficient experience with MS Word, Excel and Outlook
• Previous knowledge of employee benefits, third party benefit administration or reinsurance
• Self-directed individual that works well with minimal supervision
• Flexible; open to change and finding better ways to operate efficiently
• Excellent interpersonal and communication skills with all levels of an organization
• Ability to effectively present information and respond to questions
• Strong time management skills
• Demonstrated problem-solving and claims investigation skills
Benefits:
• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement