Highmark Health
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.
Senior Stop Loss Claims Analyst
Job not on LinkedIn
🕒 April 7
⚜️ Louisiana, North Carolina, +3 more states – Remote
💵 $23 - $35 / hour
⏰ Full Time
🟠 Senior
📋 Claims Specialist
🦅 H1B Visa Sponsor
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Highmark Health
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
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