Senior Stop Loss Claims Analyst

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🕒 April 7

⚜️ Louisiana, North Carolina, +3 more states – Remote

⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ☕ Washington – Remote

💵 $23 - $35 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

💰 $5M Grant on 2021-05

Healthcare Insurance • Non-profit • Social Impact

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Review, evaluate, and process various Stop Loss claims in accordance with established standards • Build positive client relationships and provide education • Analyze client claim losses and current issues • Follow up on pended claims as per department standards • Process daily incoming Stop Loss claims • Evaluate claims for compliance with policy provisions and regulatory guidelines • Monitor and analyze complex claims and control losses through managed care • Finalize and adjudicate claims up to a pre-determined dollar threshold • Complete pended claim letters to TPAs or brokers • Identify discrepancies in claims submissions

🎯 Requirements

• High School Diploma or GED required • 5+ years of relevant, progressive experience in health insurance claims • 3 years of prior experience processing 1st dollar health insurance claims • 3 years of experience with medical terminology • 3 years of experience in a Stop Loss Claims Analyst role preferred • Ability to communicate concise accurate information effectively • Organizational skills • Ability to manage time effectively • Ability to work independently • Problem Solving and analytical skills

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options