Specific Stop Loss Specialist

National Healthcare Solutions Group LLC• US,

3d•Onsite

About The Position

The Specific Stop Loss Specialist (SLSS) plays a critical role in managing Specific Reimbursements and Advance Funding processes 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, Excel, and Outlook
A high school diploma or GED certificate
At least 3 years' experience as a claim examiner processing first-dollar medical claims
Overall knowledge of the 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.

Nice To Haves

Stop loss insurance knowledge a plus

Responsibilities

Coordinate and file Specific Reimbursements and Advance Funding requests.
Conduct detailed research using claims data to support reimbursement processes and payments.
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
Monitor claims email box for large dollar claims that will affect Stop Loss
Assist with other administrative tasks as needed
May perform other duties as assigned.