Stop Loss Claims Specialist I – Aggregate

🕒 July 20

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $23 - $24 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Allied Benefit Systems

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1980

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Allied Benefit Systems is a national healthcare solutions company that provides health plan administration, care and cost management, provider network services, and data analytics to employers, members, and benefits consultants. The company focuses on reducing healthcare costs, optimizing plan performance, and improving member experience through administrative services, analytics & insights, and customizable provider networks.

📋 Description

• Prepare and file medical stop loss claims for reimbursement with stop loss carriers for aggregate coverage • Follow up with the various carriers to ensure reimbursements are received in time and in full • Appeals of denied and reduced claim reimbursements • Retain the appropriate documentation needed to support the reimbursement request • Compile and submit claim reports and the necessary documentation to file a stop loss claim • Frequently monitor the status of claims assigned and follow up with stop loss carriers • Answer questions and requests from stop loss carriers for additional information • Communicate with other internal departments to resolve claim issues • Manage time to file aggregate accommodation, level funded and/or final claim submissions per contract stipulations • Audit the aggregate positions, tracking the funding balance and updated reporting monthly • Prepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity

🎯 Requirements

• High School diploma or equivalent required • Some college or equivalent work experience preferred • 1 to 2 years of claims experience in a self funded environment • Thorough knowledge of Stop Loss terminologies, concepts, and catastrophic claim handling • Ability to interpret Stop Loss contracts and Client summary Plan Descriptions (SPD) • Stop loss filing experience preferred • Accounting or Finance background a plus • Proficient with Microsoft Office Suite, specifically with Microsoft Excel • Strong analytical and problem solving skills • Excellent verbal and written communication skills • Elevated level of organizational skills and superior attention to detail • Excellent time management skills with a proven ability to meet deadlines • Demonstrated ability in developing and maintaining positive relationships with team members, internal departments, various brokers, reinsurance carriers, and clients

🏖️ Benefits

• Medical • Dental • Vision • Life and Disability Insurance • Generous Paid Time Off • Tuition Reimbursement • EAP • Technology Stipend