Stop-Loss Claims Specialist: Precise, Impactful Analysis

Old Republic; United States; Presencial; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Old Republic Accident & Health is seeking a collaborative and detail-oriented Claims Specialist to join our growing team. You will process and adjudicate stop-loss claims, make reimbursement decisions based on policy details, and ensure compliance with laws and regulations.

The ideal candidate has 2–5 years of stop-loss claims reimbursement experience, familiarity with Connexure or UGAN, and CPT/ICD coding knowledge. You will collaborate with underwriting and vendors to deliver excellent service.

Formación

• 2-5 years of stop-loss claims reimbursement experience.
• Experience with claims software (Connexure or UGAN) and CPT and ICD coding knowledge.
• Demonstrated ability to manage multiple high-priority projects and meet tight deadlines.
• Strong communication and interpersonal skills with the ability to convey information clearly.
• Bachelor's degree in business or related field.

Responsabilidades

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

Conocimientos

Stop-loss claims

Regulatory knowledge

Communication

Analytical thinking

Educación

Bachelor's in business

Herramientas

Connexure

UGAN

CPT coding

ICD coding

Descripción del empleo

Old Republic Accident & Health is seeking a collaborative and detail-oriented Claims Specialist to join our growing team. You will process and adjudicate stop-loss claims, make reimbursement decisions based on policy details, and ensure compliance with laws and regulations.

The ideal candidate has 2–5 years of stop-loss claims reimbursement experience, familiarity with Connexure or UGAN, and CPT/ICD coding knowledge. You will collaborate with underwriting and vendors to deliver excellent service.