Aggregate Stop Loss Specialist

National Healthcare Solutions, Inc.

10d

About The Position

The Aggregate Stop Loss Specialist (ALSS) plays a critical role in managing Aggregate reporting and filings for self-funded and level-funded clients. This position requires a strong grasp of claims processing to conduct effective informational research and ensure accurate coordination and filing.

Requirements

• Intermediate level computer skills, including Microsoft Word, and Outlook
• Advanced Excel required
• A high school diploma or GED certificate
• At least 3 years' experience as a claim’s examiner processing first dollar medical claims
• Stop loss insurance knowledge required
• Overall knowledge of Healthcare industry
• Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
• Strong communication and organizational skills
• Excellent written and verbal communication skills

Responsibilities

• Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests
• Conduct detailed research using claims data to support reimbursement processes and payments
• Respond promptly and thoroughly to audit requests by gathering (or directing appropriate parties) to gather the requested information for pre-audit work; review all information being sent out for accuracy and appropriateness
• Documentation of authorizations and/or denials by the stop loss carriers
• Maintain professional communication with internal teams, vendors and clients
• Operate independently while meeting deadlines and compliance standards
• Manage and track the received, pended and completed claim files
• Document escalations and/or authorizations for release of claim payments
• Assist with other administrative tasks as needed

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees