[Remote] Stop Loss Claims Specialist I-Aggregate

Note: The job is a remote job and is open to candidates in USA. Allied Benefit Systems is a company that focuses on claims management and insurance solutions. They are seeking a Stop Loss Claims Specialist I-Aggregate who will be responsible for preparing and filing medical stop loss claims for reimbursement with carriers, as well as following up to ensure timely reimbursements and handling appeals for denied claims.

Responsibilities

• Compile and submit claim reports and the necessary documentation to file a stop loss claim
• Frequently monitor the status of claims assigned and follow up with stop loss carriers
• Strong ability to answer questions and requests from stop loss carriers for additional information promptly and with thorough information in support of claim reimbursement
• Communicate with other internal departments to resolve claim issues
• Ability to manage time to file aggregate accommodation, level funded and/or final claim submissions per contract stipulations
• Appeal the denials or reduction of reimbursements by the stop loss carrier
• Responsible for auditing the aggregate positions, tracking the funding balance and updated reporting monthly
• Prepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity
• Understand stop loss policy provisions, as well as group plan documentation in support of claim reimbursements
• Ability to adapt to new concepts and systems
• Other duties as assigned

Skills

• High School diploma or equivalent required
• 1-2 years of claims experience in a self-funded environment
• Have a thorough knowledge of Stop Loss terminologies, concepts, and catastrophic claim handling
• Ability to interpret Stop Loss contracts and Client summary Plan Descriptions (SPD)
• Proficient with Microsoft Office Suite, specifically with Microsoft Excel
• Strong analytical and problem-solving skills
• Excellent verbal and written communication skills
• Demonstrated elevated level of organizational skills and superior attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Demonstrated ability in developing and maintaining positive relationships with team members, internal departments, various brokers, reinsurance carriers, and clients
• Some college or equivalent work experience preferred
• Stop loss filing experience preferred
• Accounting or Finance background a plus

Benefits

• Medical
• Dental
• Vision
• Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend

Company Overview