Specific Stop Loss Claims Auditor

001 Brown & Brown, Inc; United States; Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Health benefits

401k

Tuition reimbursement

Paid time off

Job summary

Brown & Brown is seeking a Specific Stop Loss Claims Auditor to join our growing team. The incumbent will provide Specific Stop Loss claims auditing services for MGU and/or Carrier clients and collaborate with TPAs.

The role requires Excel proficiency, 2+ years of claims experience (stop loss, HMO reinsurance, or provider excess), and strong analytical and communication skills. Pay range is substantial with comprehensive benefits.

Qualifications

• Must have Excel proficiency including basic formulas, sorting, and Pivot Tables.
• Minimum 2 years claims experience with first-dollar medical, specific/aggregate stop loss, HMO reinsurance, or provider excess claims.
• Experience with industry repricing methodologies (PPO, Wrap Networks, Reference Based Pricing, etc.).
• Demonstrated proficiency in Microsoft Office including Outlook.
• Strong analytical/critical thinking and detail orientation; excellent written and verbal communication.
• Ability to work independently with minimal supervision.

Responsibilities

• Analyze Specific Stop Loss claims.
• Identify and isolate data for specific claim submissions.
• Validate expenses under the stop loss policy and SPDs.
• Accurately apply deductibles and coinsurance; manage lasers.
• Provide customer service for MGU partners and TPAs.
• Follow up on all pended claims promptly.
• Contribute to process improvements and new workflows.

Skills

Excel Proficiency

Claims experience

HMO reinsurance

PPO pricing

Microsoft Office

Analytical skills

Communication skills

Independent work

Managed care audit

Tools

Pivot Tables

Microsoft Outlook

Job description

Built 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

• 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.

The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

We think of ourselves as a team, so we have teammates - not employees. We strive to attract people who are competitive, driven, and disciplined.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

Founded in 1939 as a small, two-partner firm, Brown & Brown (NYSE: BRO) and our team of companies have grown into one of the world’s largest insurance brokerages while staying true to our foundation of trust, resilience, and delivering results.

With a team that is as connected locally as it is globally, our high-performing, highly collaborative team delivers innovative risk and insurance solutions.

We look for individuals who embrace our culture, thrive in a collaborative environment, are driven to grow and succeed, and are committed to always doing what is right.

With a unique culture built on integrity, superior capabilities and grit, we value teamwork, trust and courage.

We think of ourselves as a team, so we have teammates—not employees, and leaders—not managers.

Everything we do is about the greater “WE”—never “me.”While diverse in abilities and experience, we are all connected through our core values, a commitment to our local communities and a shared mission—always doing what is best for our customers.