Junior Claims Examiner

Beyond Risk Management Inc•Beverly, MA

33d•Onsite

About The Position

We are seeking an entry-level stop loss claims professional to join our dynamic team! As a Junior Claims Examiner, you will manage the administrative functions for the claims department while learning the fundamentals of auditing and processing medical stop loss insurance claims.

Requirements

Bachelor's degree in a related field or equivalent work experience.
Strong analytical skills with the ability to interpret complex claims data.
Excellent attention to detail and accuracy in data entry and documentation.
Effective communication skills, both verbal and written, with the ability to interact professionally with internal and external parties.
Proficiency with Microsoft Office applications (Excel, Word, Outlook, PowerPoint), and ability to learn new computer systems and technology quickly.
Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
A positive attitude, commitment to teamwork, and an eagerness to learn are critical to success in this role.
Candidate must be local to the Beverly, Massachusetts area, as this role is required to be in the office five days per week upon hire. After three months of employment, there is potential for a hybrid schedule, at management’s discretion, with no less than three days in the office per week.

Responsibilities

Monitor Claims mailboxes for multiple programs, promptly and accurately logging initial and subsequent claims submissions, notices, and reporting in the claims system.
Format claims detail spreadsheets and import to the appropriate claim submission.
Review claim submissions, identify missing information, and communicate with TPA partners to obtain required documentation.
Train cross-functionally across the organization to develop a deep understanding of the medical stop loss industry.
Assist Claim Examiners with following up for requested information on pended claim files and compiling documentation to submit to carrier partners, as required.
Assist with claims reimbursement processes, including distribution of Explanations of Reimbursement.
Work closely with the Claims team to learn the process of auditing a claim from beginning to end, gradually taking on additional responsibilities related to auditing claim files.
Progressively work toward handling claim submissions autonomously, including but not limited to verification of eligibility and coverage under the plan document and stop loss policy, identification of cost containment opportunities, and requesting additional information, as required.
Maintain detailed and organized records of claims activities, including correspondence, payments, case reserves, and resolutions.
Ensure compliance with all relevant regulations, policies, and procedures governing medical stop loss insurance claims processing.
Cross trains with departments throughout the organization to provide assistance during periods of high-volume activity. Completes special projects as assigned by management.