Specific Stop Loss Claims Auditor

Brown & Brown Insurance

3d•$75,000 - $90,000•Onsite

About The Position

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking a Specific Stop Loss Claims Auditor to join our growing team. Corporate Benefit Audits, Inc. (CBA), a division of Risk Strategies Company, headquartered in North Andover, MA since 1992, has provided audit services to Carriers, MGU’s, Reinsurers and Employer clients managing healthcare risk and associated Stop Loss Reinsurance concerns. The incumbent is responsible for providing Specific Stop Loss claims auditing services for MGU and/or Carrier clients.

Requirements

Must have Excel Proficiency to include 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.

Nice To Haves

Prior experience auditing managed care or specific/aggregate stop loss claims.
History of successful Process Improvement initiatives.

Responsibilities

Analyze Specific Stop Loss claims.
Identify and isolate the data that is specific to a particular claim submission.
Validate which expenses are eligible under the stop loss policy and summary plan description.
Accurately apply all 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 the implementation of new processes.