Claims/Customer Service Representative

The Stop Loss Rep works with Reinsurance Carriers in filing for reimbursement for groups that have claimants that have gone over the Specific Stop Loss deductible.

Requirements:

1. High School graduate or equivalent.
2. Motivated and works independently.
3. Detail oriented with good problem solving skills.
4. Ability to prioritize and meet deadlines.
5. Proficient in basic math skills.
6. Proficient in Microsoft Office products.
7. Adaptable to changes.

Desired:

1. Two (2) years of insurance experience in a claims processing and/or call center environment.
2. Familiar with insurance terminology.
3. Knowledge of stop loss/reinsurance.

Responsibilities:

1. Maintain a positive working relationship with others.
2. Communicate with internal and external customers in a timely, professional and friendly manner.
3. Determine claims potentially eligible for filing.
4. Demonstrate the proper sense of urgency needed for obtaining all information for filing or preparing to file stop loss claims.
5. Communicates with Account Executives to obtain information from the Client required by the stop loss carrier.
6. Files stop loss claims in an accurate, complete and timely manner.
7. Run and/or proved stop loss reporting accurately and timely including both internally and externally.
8. Works with stop loss carriers, Account Executives, Claims Team, Financial and Eligibility Departments to resolve issues at the root cause.
9. Records and communicates all information clearly and accurately.
10. Keep all member's protected health information (PHI) confidential.