Stop Loss Claims Processing Associate

Job Overview
We are seeking a detail-oriented and organized Administrative Assistant to support our team in various administrative tasks. The ideal candidate will possess strong computer literacy skills and have experience in administrative functions, ensuring smooth operations within the office. This role is essential for maintaining efficient workflows and providing excellent support to our staff and clients.

Summary

The Stop Loss Claims Administrative Assistant is responsible for the reconciliation of information/documentation from stop loss carriers, providing requested information as part of the claims audit and the adjudication and reconciliation of Aggregate Stop Loss Claims.

Duties

• Perform data entry tasks accurately and efficiently, maintaining up-to-date records.
• Submitting all requested information to carriers.
• Tracking assigned tasks to completion.
• Maintaining record of funds owed per carrier along with weekly follow-up of the same
• Reporting to supervisor regularly the status of each carrier
• Manage calendars, scheduling appointments, and coordinating meetings for team members.
• Assist with filing and organizing documents, ensuring easy access to information.
• Utilize QuickBooks for basic accounting tasks, including invoicing and expense tracking.
• Provide clerical support by answering phone calls and responding to emails
• Collaborate with team members on various projects, contributing to a positive work environment.
• Perform RCA when necessary to address issues or errors.
• Review of reporting submitted to carriers to determine accuracy and efficiency.

Skills

• Review Aggregate Claim Reports and other related documentation
• Review and adjudicate Monthly Aggregate Accommodation Requests, taking into consideration all applicable Stop Loss Policy Provisions, Plan Document Provisions, and internal claims processing protocols, within assigned authority limit.
• Regularly follow up with members, groups and carriers to check status of our requests for information/documentation in pended claim scenarios.
• Proficient in computer literacy with a strong command of Microsoft Office Suite (Word, Excel, PowerPoint).
• Experience with QuickBooks or similar accounting software is preferred.
• Experience with third party administration, self-funding, stop loss claims, excess loss claims, and/or reinsurance is preferred. Aggregate claim experience is also preferred.
• Knowledge of CPT, ICD-10, and HCPCS codes, along with knowledge of medical claim practices.
• Strong analytical skills/abilities, along with having keen critical decision-making and problem-solving skills, are a must.
• Strong data entry skills with attention to detail to ensure accuracy.
• Excellent calendar management abilities to effectively coordinate schedules.
• Previous experience as a clerk or in an administrative role is advantageous.
• Ability to maintain confidentiality and handle sensitive information appropriately.
• Exceptional verbal and written communication skills, along with sound organizational skills, and effective customer service abilities

If you are a motivated individual looking to contribute your skills in a dynamic environment, we encourage you to apply for this exciting opportunity as a Stop Loss Administrative Assistant.

Job Type: Full-time

Pay: From $16.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Location:

• High Point, NC 27260 (Preferred)

Shift availability:

• Day Shift (Required)

Ability to Commute:

• High Point, NC 27260 (Required)

Ability to Relocate:

• High Point, NC 27260: Relocate before starting work (Required)

Work Location: In person

Salary : $16