Claims Examiner

Job Description

Job Description

Job Description :

SL Management Partners, LLC is seeking an experienced stop loss Claims Examiner to join our dynamic team. As a Claims Examiner, you will play a crucial role in ensuring the accurate and efficient processing of medical stop loss insurance claims. Your primary responsibility will be to review and analyze claims data, audit claim submissions for reimbursement, and facilitate timely claims settlements. Preference will be given to local candidates, but remote arrangements may be considered based on experience level.

Responsibilities :

• Claims Processing : Efficiently process employer stop loss insurance claims for multiple carrier partners, according to established carrier procedures and regulatory guidelines. Issue payments within authority limits and submit requests for payments over the assigned authority limits to the appropriate manager for approval.
• Review and Analysis : Conduct thorough reviews of claims documentation to verify accuracy, completeness, and compliance with policy terms.
• Investigation : Audit claim submissions for reimbursement, including but not limited to verification of eligibility and coverage under the plan document and stop loss policy, identification of cost containment opportunities, and requesting additional information, as required.
• Communication : Communicate with TPAs, producers, healthcare providers, vendors, and internal management to obtain necessary information and facilitate claims processing.
• Documentation : Maintain detailed and organized records of claims activities, including correspondence, payments, case reserves, and resolutions.
• Quality Assurance : Perform quality assurance checks to ensure claims processing accuracy and adherence to company standards.
• Continuous Improvement : Identify opportunities for process improvement and contribute to the enhancement of claims processing efficiency and effectiveness.
• Compliance : Ensure compliance with all relevant regulations, policies, and procedures governing medical stop loss insurance claims processing.
• Other Duties as Assigned : Assists with logging new claim submissions, notifications, and claims reporting as needed. Cross trains with departments throughout the organization to provide assistance during periods of high-volume activity. Completes special projects as assigned by management.

Qualifications :

Why Join Us :

If you're ready to make an impact and grow your career in a dynamic, forward-thinking company, we’d love to hear from you! Apply today to join our team.

Equal Opportunity Employer

SL Management Partners and Beyond Risk provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.