Stop Loss Claims Specialist I-Aggregate

Paycom - ATS; United States; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life and Disability Insurance

Paid Time Off

Tuition Reimbursement

Technology Stipend

Job summary

Allied in the United States is seeking a Stop Loss Claim Specialist to prepare and file stop loss claims for aggregate coverage. You will monitor claim status, follow up with carriers, and appeal denials while maintaining proper documentation and timely reporting.

Ideal candidates have 1-2 years of self-funded claims experience, strong Excel skills, and the ability to interpret Stop Loss contracts and SPD. Remote work is supported with a comprehensive benefits package.

Qualifications

• 1-2 years of claims experience in a self-funded environment.
• Strong knowledge of Stop Loss terminologies, concepts, and catastrophic claim handling.
• Ability to interpret Stop Loss contracts and SPD.
• Proficient with Microsoft Office Suite, especially Excel.

Responsibilities

• Compile and submit claim reports and the necessary documentation to file a stop loss claim.
• Frequently monitor the status of claims assigned and follow up with stop loss carriers.
• Audit the aggregate positions, tracking the funding balance and updated reporting monthly.
• Prepare year-end and monthly accommodation aggregate claim filings upon reconciliation.
• Appeal the denials or reductions by the stop loss carrier.

Skills

Claims experience

Stop Loss knowledge

Contract interpretation

Excel

Analytical skills

Time management

Communication skills

Education

High School diploma

Some college coursework preferred

Tools

Microsoft Office

Excel

Job description

POSITION SUMMARYThe Stop Loss Claim Specialist is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers for aggregate coverage. Additional duties include following up with the various carriers to ensure reimbursements are received in time and in full. Further responsibilities include the appeals of denied and reduced claim reimbursements, along with retaining the appropriate documentation needed to support the reimbursement request.ESSENTIAL FUNCTIONSCompile and submit claim reports and the necessary documentation to file a stop loss claim.Frequently monitor the status of claims assigned and follow up with stop loss carriers.Strong ability to answer questions and requests from stop loss carriers for additional information promptly and with thorough information in support of claim reimbursement.Communicate with other internal departments to resolve claim issues.Ability to manage time to file aggregate accommodation, level funded and/or final claim submissions per contract stipulations.Appeal the denials or reduction of reimbursements by the stop loss carrier.Responsible for auditing the aggregate positions, tracking the funding balance and updated reporting monthlyPrepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity.Understand stop loss policy provisions, as well as group plan documentation in support of claim reimbursements.Ability to adapt to new concepts and systems.Other duties as assigned.EDUCATIONHigh School diploma or equivalent required.Some college or equivalent work experience preferred.EXPERIENCE AND SKILLS1 to 2 years of claims experience in a self funded environmentHave a thorough knowledge of Stop Loss terminologies, concepts, and catastrophic claim handlingAbility to interpret Stop Loss contracts and Client summary Plan Descriptions (SPD).Stop loss filing experience preferredAccounting or Finance background a plus.Proficient with Microsoft Office Suite, specifically with Microsoft Excel.Strong analytical and problem solving skills.Excellent verbal and written communication skills.Demonstrated elevated level of organizational skills and superior attention to detail.Excellent time management skills with a proven ability to meet deadlines.Demonstrated ability in developing and maintaining positive relationships with team members, internal departments, various brokers, reinsurance carriers, and clients.POSITION COMPETENCIESAccountabilityCommunicationCustomer Service OrientationFunctional/Technical SkillsQuality FocusTime and Task ManagementPHYSICAL DEMANDSThis is a standard desk role requiring extended sitting and computer work.WORK ENVIRONMENTRemoteHere at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.