Remote Stop-Loss Claims Auditor (Specific)

Brown & Brown, Inc.; Northern (KY); Hybrid; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical/Rx benefits

Dental/Vision benefits

Life Insurance

Disability Insurance

401k/ESPP

Job summary

Brown & Brown, Inc. is seeking a Specific Stop Loss Claims Auditor to join our growing team. This role focuses on auditing Specific Stop Loss claims for MGU and Carrier clients, ensuring accurate application of deductibles and policy terms while addressing data specific to each claim submission.

You will provide customer service to MGU partners and TPAs, conduct timely follow ups on pended claims, and contribute to process improvements with innovative ideas and efficient workflows.

Qualifications

• Experience with first dollar medical claims and stop loss.
• Knowledge of PPO, wrap networks, reference-based pricing.
• Proficient in Microsoft Office including Outlook.
• Strong analytical and detail-oriented skills.
• Excellent written and verbal communication.
• Ability to work independently with minimal supervision.

Responsibilities

• Analyze Specific Stop Loss claims and isolate data for each submission.
• Validate expenses and apply deductibles, coinsurance, aggregating deductibles, and lasers.
• Provide customer service for MGU partners and their TPAs.
• Conduct timely follow ups on pended claims.
• Suggest and assist with process improvement initiatives.

Skills

Excel proficiency

Analytical thinking

Attention to detail

Written and verbal communication

Tools

Excel

Microsoft Office

Pivot Tables

Outlook

Job description

Brown & Brown, Inc. is seeking a Specific Stop Loss Claims Auditor to join our growing team. This role focuses on auditing Specific Stop Loss claims for MGU and Carrier clients, ensuring accurate application of deductibles and policy terms while addressing data specific to each claim submission.

You will provide customer service to MGU partners and TPAs, conduct timely follow ups on pended claims, and contribute to process improvements with innovative ideas and efficient workflows.