Remote Stop-Loss Claims Auditor: Validate & Optimize Claims

Imagine360, LLC; United States; Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Multiple Health plan options

Paid employee premiums for insurance

Parental Leave Policy

20 days PTO

10 Paid Holidays

Tuition reimbursement

401k Company contribution

Professional development initiatives

Job summary

Imagine360, LLC is looking for a Stop Loss Claims Auditor to join their team in a fully remote capacity. This individual will work within the Stop Loss Department, ensuring claims are examined, audited, and processed accurately to support multiple functions.

The ideal candidate should have an Associate or Bachelor's Degree, along with 3-5 years of medical claims processing experience. Strong communication and analytical skills are essential for success in this role, as well as a solid

Qualifications

• 3-5 years of processing first dollar medical claims.
• Experience in Stop Loss Claims and Stop Loss industry.
• Prior experience in self-insured plan management.

Responsibilities

• Monitor claims inbox and respond timely to claims.
• Audit submitted claims for correct benefits payments.
• Prepare rationales for claim decisions based on evidence.
• Facilitate advance funding with Finance Department.

Skills

Strong communication

Interpersonal skills

Analytical skills

Problem-solving

Detail oriented

Microsoft Office

Multitasking

Knowledge of HIPAA

Medical Terminology

CPT

ICD-10

Education

Associate or Bachelor's Degree

Job description

Imagine360, LLC is looking for a Stop Loss Claims Auditor to join their team in a fully remote capacity. This individual will work within the Stop Loss Department, ensuring claims are examined, audited, and processed accurately to support multiple functions.

The ideal candidate should have an Associate or Bachelor's Degree, along with 3-5 years of medical claims processing experience. Strong communication and analytical skills are essential for success in this role, as well as a solid