Stop Loss Claims Auditor
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Job Description
Specific Stop Loss Claims Auditor auditing healthcare claims for Brown & Brown’s risk-management clients. Applying stop-loss policy rules, deductibles, coinsurance, and repricing methodologies.
Responsibilities:
- Analyze Specific Stop Loss claims
- Identify and isolate data specific to a particular claim submission
- Validate which expenses are eligible under the stop loss policy and summary plan description
- Accurately apply deductibles, coinsurances, aggregating specific deductibles and lasers
- Provide customer service for MGU partners and their respective TPAs
- Conduct timely follow-up on all pended claims
- Contribute innovative ideas and assist with implementation of new processes
Requirements:
- Must have Excel proficiency, including knowledge of basic formulae, sorting techniques and Pivot Tables
- Minimum 2 years claims experience with first dollar medical claims, specific and/or aggregate claims, HMO reinsurance and/or provider excess claims
- Prior experience with industry repricing methodologies (PPO, Wrap Networks, Reference Based Pricing, etc.)
- Demonstrated proficiency in Microsoft Office, including Microsoft Outlook
- Demonstrated strong analytical/critical thinking skills and detail-oriented focus
- Strong written and verbal communication skills
- Ability to work independently with minimal supervision
- Preferred: Prior experience auditing managed care or specific/aggregate stop loss claims
- Preferred: History of successful Process Improvement initiatives
Benefits:
- Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
- Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
- Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
- Paid Time Off
- Holidays
- Preferred Partner Discounts
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