Senior Stop-Loss Claims Analyst

Allied National, LLC; Overland Park (KS); Sur place; USD 60 000 - 90 000; Plein temps

Résumé du poste

Allied National, LLC seeks a Stop Loss Claims Specialist to join our team in Overland Park, KS. You will identify, track, review, and process stop-loss reimbursements on behalf of carriers within an MGU stop-loss operation.

The ideal candidate has strong knowledge of medical claims, interpretation of stop-loss contracts, and experience managing large claims in self-funded environments. This role emphasizes accuracy, audit trails, and timely processing.

Qualifications

• Must have 3+ years of experience in medical claims processing, stop-loss administration, aggregate claim review and processing, or a related self-funded environment.
• Must be able to read, interpret, and apply stop-loss contracts, policy language, and supporting plan documents.

Responsabilités

• Review and process specific and aggregate stop-loss claims in accordance with policy provisions, carrier guidelines, and internal procedures
• Interpret stop-loss contracts and supporting plan documents to determine reimbursement eligibility, required documentation, and claim disposition
• Monitor high-cost and ongoing claims for reimbursement potential and follow up on outstanding submissions or requests for additional information
• Prepare, track, and report specific and aggregate claim activity, including aggregate accommodation calculations, monthly reporting, and audit support
• Analyze claims, medical documentation, and supplemental materials to ensure timely, accurate claim handling and clear audit trails

Connaissances

Medical claims processing

Stop-loss knowledge

Analytical skills

Independent work

Formation

High school diploma or equivalent

Associate degree in related field

Bachelor's degree in related field

Description du poste

Allied National, LLC seeks a Stop Loss Claims Specialist to join our team in Overland Park, KS. You will identify, track, review, and process stop-loss reimbursements on behalf of carriers within an MGU stop-loss operation.

The ideal candidate has strong knowledge of medical claims, interpretation of stop-loss contracts, and experience managing large claims in self-funded environments. This role emphasizes accuracy, audit trails, and timely processing.