Aggregate Stop-Loss Claims & Reconciliation Expert

Independent Medical Systems, Inc.; Idaho; Sur place; USD 55 000 - 85 000; Plein temps

Résumé du poste

Assured Benefits Administrators, Inc. (ABA) in the United States seeks an Aggregate Stop Loss Specialist to manage aggregate reporting for self-funded plans.

You will research claims data, file reimbursements, and coordinate with carriers to ensure accuracy and audit readiness. This role requires 3+ years as a claims examiner processing first-dollar medical claims, stop-loss insurance knowledge, and strong Excel skills in a fast-paced environment.

Qualifications

• Associate degree preferred; equivalent combination of education and experience considered.
• Intermediate level computer skills, including Word and Outlook.
• Advanced Excel required.

Responsabilités

• Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests per carrier policies.
• Research claims data to validate thresholds, accumulators, and eligibility.
• Respond to audit requests and gather documentation for accuracy before release.
• Document authorizations and denials from stop-loss carriers; track escalations and approvals.
• Maintain professional communication with internal teams, vendors, carriers, brokers, and clients.

Connaissances

Claims knowledge

Excel

Communication

Attention to detail

Formation

Associate degree preferred

High school diploma or GED

Outils

Microsoft Word

Outlook

Description du poste

Assured Benefits Administrators, Inc. (ABA) in the United States seeks an Aggregate Stop Loss Specialist to manage aggregate reporting for self-funded plans.

You will research claims data, file reimbursements, and coordinate with carriers to ensure accuracy and audit readiness. This role requires 3+ years as a claims examiner processing first-dollar medical claims, stop-loss insurance knowledge, and strong Excel skills in a fast-paced environment.