Stop Loss Claims Analyst

Position Overview:

The Claims Analyst is responsible for providing assistance to the Director, Claims and Clinical while ensuring that claims are properly adjudicated in accordance with our contract and the underlying Plan/Group contracts. 

This position will report to the Director, Claims and Clinical. 

Essential Elements

• Review, analyze, manage, and adjudicate claims on the Stop Loss and Excess of Loss book of business to determine action to be taken
• Research and resolve claim issues by identifying and analyzing problems and/or risks, and assembling the documentation needed to support the recommendation to resolve the problem  
• Maintain applicable logs, files, and company turnaround time standards.
• Maintain knowledge of the insurance industry through continuing education
• Other tasks as assigned

Requirements:

Education and Certifications:

• Bachelor’s degree or commensurate experience required
• Insurance industry designations preferred

Experience:

• Knowledge of current state issues, regulations and industry trends as it relates to claims required
• Demonstrate proficiency with computer software including Microsoft Office Suite, with advanced skills in Excel required
• Knowledge of COB, Medicare, HIPPA, CPT, ICD-10, COBRA and benefit plan interpretation preferred
• Knowledge of medical insurance stop-loss contracts and self-funded plans preferred
• Understanding and experience with data analytics preferred

Travel:

• Limited travel will be required