Stop Loss Claims Specialist I

🔥 13 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $23 - $24 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 individual stop loss (specific) coverage • Compile and submit claim reports and necessary supporting documentation • Monitor assigned claim status and follow up with stop loss carriers • Respond promptly and thoroughly to carrier questions and requests for additional information • Communicate with internal departments to resolve claim issues • Prepare initial, subsequent, and year-end claim filings after reconciling claim activity • Manage advanced funding, high-dollar, and renewal claim submissions according to contract stipulations and department metrics • Appeal denied or reduced reimbursements • Understand and apply stop loss policy provisions and group plan documentation • Adapt to new concepts and systems • Perform other duties as assigned

🎯 Requirements

• High School diploma or equivalent required • 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) • Proficient with Microsoft Office Suite, specifically Microsoft Excel • Strong analytical and problem solving skills • Excellent verbal and written communication skills • Elevated organizational skills and superior attention to detail • Excellent time management skills with a proven ability to meet deadlines • Ability to develop and maintain positive relationships with team members, internal departments, brokers, reinsurance carriers, and clients • Cable broadband or fiber optic internet service with at least 100Mbps download/25Mbps upload

🏖️ Benefits

• Medical Insurance • Dental Insurance • Vision Insurance • Life and Disability Insurance • Generous Paid Time Off • Tuition Reimbursement • Employee Assistance Program (EAP) • Technology Stipend • Fully remote work • Flexible work-from-home arrangement