Stop Loss Claims Analyst

Job Summary

A company is looking for a Stop Loss Claims Analyst to evaluate and process claim submissions for reimbursement eligibility.

Key Responsibilities

• Process an average of 5 to 7 claims per day while maintaining a processing accuracy of 99% or better
• Determine eligibility of claims by applying contractual provisions to medical facts and specifications
• Document claim decisions and elevate issues to supervision as necessary

Required Qualifications

• 5+ years of stop loss claims experience
• Prior experience with first dollar payer insurance (medical healthcare claims)
• Knowledge of medical billing practices, CPT codes, and revenue codes
• Ability to use mathematics for claim adjudication
• Demonstrated proficiency in Microsoft Office software