Specific Stop Loss Claims Auditor

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

## Specific Stop Loss Claims AuditorApply: Remote - USA: Full time: Posted Today: R26\\_0000003137Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.**Brown & Brown** is seeking a **Specific Stop Loss Claims Auditor** to join our growing team.Corporate Benefit Audits, Inc. (CBA), a division of Risk Strategies Company, headquartered in North Andover, MA since 1992, has provided audit services to Carriers, MGU’s, Reinsurers and Employer clients managing healthcare risk and associated Stop Loss Reinsurance concerns. The incumbent is responsible for providing Specific Stop Loss claims auditing services for MGU and/or Carrier clients.**How You Will Contribute:*** Analyze Specific Stop Loss claims.* Identify and isolate the data that is specific to a particular claim submission.* Validate which expenses are eligible under the stop loss policy and summary plan description.* Accurately apply all deductibles, coinsurances, aggregating specific deductibles and lasers.* Provide customer service for MGU partners and their respective TPAs.* Conduct timely follow up on all pended claims.* Contribute innovative ideas and assist with the implementation of new processes.**Skills & Experience to be Successful:*** Must have Excel Proficiency to include knowledge of basic formulae, sorting techniques and PIVOT Tables.* Minimum 2 years Claims experience with first dollar medical claims, specific and/or aggregate claims, HMO reinsurance and/or provider excess claims.* claims, HMO reinsurance and/or provider excess claims.* Prior experience with industry repricing methodologies. (PPO, Wrap Networks, Reference Based Pricing, etc.).* Demonstrated proficiency in Microsoft Office, including Microsoft Outlook.* Demonstrated strong analytical/critical thinking skills; and detail‐oriented focus.* Strong written and verbal communication skills.* Ability to work independently with minimal supervision.**Preferred*** Prior experience auditing managed care or specific/aggregate stop loss claims.* History of successful Process Improvement initiatives.**Pay Range**75,000.00 - 90,000.00 Annual*The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.***Teammate Benefits & Total Well-Being**We go beyond standard benefits, focusing on the total well-being of our teammates, including:* *Health Benefits*: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance* *Financial Benefits*: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement* *Mental Health & Wellness*: Free Mental Health & Enhanced Advocacy Services* *Beyond Benefits*: Paid Time Off, Holidays, Preferred Partner Discounts and more.*Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.*