Stop-Loss Claims Strategist

Allied-National; Overland Park (KS); Vor Ort; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

Allied-National is seeking a Stop Loss Claims Specialist to join our team in Overland Park, KS. You will identify, track, review, and process stop-loss reimbursements for carriers within a managed stop-loss operation.

The ideal candidate has 3+ years in medical claims processing, a strong understanding of stop-loss contracts, and experience in self-funded or TPA environments. Join a collaborative team focused on accurate, timely claim handling.

Qualifikationen

• Must have a high school diploma or equivalent.
• 3+ years of experience in medical claims processing, stop-loss administration, aggregate claim review, or related self-funded environment.
• Ability to read, interpret, and apply stop-loss contracts and plan documents.

Aufgaben

• Review and process stop-loss claims in accordance with policy provisions and procedures.
• Interpret stop-loss contracts and plan documents to determine reimbursement eligibility and claim disposition.
• Monitor high-cost and ongoing claims and follow up on required information.
• Prepare and report claim activity, including aggregate calculations and monthly reports.
• Analyze claims and medical documentation to ensure timely, accurate handling and audit trails.

Kenntnisse

Medical claims processing

Stop-loss administration

Aggregate claim review

Large claim review

Self-funded environment

Ausbildung

High school diploma or equivalent

Associate or Bachelor's degree in related field

Jobbeschreibung

Allied-National is seeking a Stop Loss Claims Specialist to join our team in Overland Park, KS. You will identify, track, review, and process stop-loss reimbursements for carriers within a managed stop-loss operation.

The ideal candidate has 3+ years in medical claims processing, a strong understanding of stop-loss contracts, and experience in self-funded or TPA environments. Join a collaborative team focused on accurate, timely claim handling.