Stop-Loss Claims Specialist: Data-Driven & Collaborative

Old Republic Accident & Health; United States; On-site; USD 65,000 - 95,000; Full time

Job summary

Old Republic Accident & Health is seeking a meticulous Claims Specialist to join our fast-growing team. You will ensure accuracy on policy documents, make prompt decisions based on detailed analysis of complex issues, and partner effectively with TPAs, vendors, MGUs, brokers, and other stakeholders to resolve claims.

The ideal candidate has 2–5 years of stop-loss claims reimbursement experience, strong communication and problem-solving skills, and a Bachelor’s degree in business or a related

Qualifications

• 2–5 years of stop-loss claims reimbursement experience.
• Bachelor’s degree in business or related field.
• Knowledge of relevant insurance regulations preferred.
• Ability to manage multiple high-priority projects concurrently and meet deadlines.

Responsibilities

• Process and adjudicate stop loss claims for timely, accurate resolutions.
• Make reimbursement decisions based on policy documents, plan details, and cost containment strategies.
• Authorize and process payments or denials after investigation and analysis.
• Review billed procedure and diagnosis codes for billing irregularities.
• Ensure compliance with laws and regulations.
• Develop quantitative analyses of claims issues.
• Analyze claim data and trends to identify process improvements.
• Collaborate with underwriting, clinical, and business development teams to address client needs.
• Build and maintain strong relationships with TPAs, vendors, MGUs, brokers, and stakeholders.

Skills

Communication

Problem solving

Multitasking

Autonomy

Education

Bachelor's degree in business or related field

Tools

Connexure

UGAN

CPT coding

ICD coding

Job description

Old Republic Accident & Health is seeking a meticulous Claims Specialist to join our fast-growing team. You will ensure accuracy on policy documents, make prompt decisions based on detailed analysis of complex issues, and partner effectively with TPAs, vendors, MGUs, brokers, and other stakeholders to resolve claims.

The ideal candidate has 2–5 years of stop-loss claims reimbursement experience, strong communication and problem-solving skills, and a Bachelor’s degree in business or a related