Stop Loss Claims Analyst

Berkley • Hamilton Township, NJ

119d • $70,000 - $80,000

About The Position

As a Stop Loss Claims Analyst, you'll perform quality review and evaluation of all claim submissions received and logged into our claims system to determine whether the amount requested is eligible for reimbursement. This position can either be fully remote (if not within commutable distance to the office) or based in our Hamilton Square, NJ office which offers a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.

Requirements

• 3-5+ years stop loss claims experience
• Prior experience handling first dollar payer insurance (medical healthcare claims)
• Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
• Ability to use mathematics to adjudicate claims
• Detail oriented with a high degree of accuracy and ability to multitask
• Strong problem solving, decision-making, reporting and analytical skills
• Must possess good judgment and work effectively with internal business areas, peers and co-workers
• Demonstrated proficiency in Microsoft Office software

Nice To Haves

• Prior experience handling stop loss claims at the reinsurance level (medical healthcare claims)
• Ability to work independently, prioritize, organize and assign own work to meet deadlines
• Ability to accept changing priorities with a minimum of disruption

Responsibilities

• Process an average of 5 to 7 claims per day
• Maintain a processing accuracy of 99% or better
• Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
• Review and adjudicate claims within approved authority limits
• Maintain assigned claim block and assist other team members while meeting departmental guidelines
• Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.
• Elevate issues to next level of supervision, as appropriate
• Other duties as assigned

Benefits

• Competitive compensation
• Paid time off
• Comprehensive wellness benefits and programs
• Employer funded health savings account
• Profit sharing
• 401k
• Paid parental leave
• Employee stock purchase plan
• Tuition assistance
• Professional continuing education

What This Job Offers

• Job Type: Full-time
• Number of Employees: 5,001-10,000 employees