Senior Stop Loss Claims Analyst

Highmark Health

Base: $23.16 - $35.88 ph; bonus/equity: not specif...
5 years health insurance claims experience
3 years first dollar claims processing
Medical terminology proficiency
The role involves reviewing and processing complex Stop Loss claims in accordance with established quality standards and turnaround times

Job Summary

  • The role involves reviewing and processing complex Stop Loss claims in accordance with established quality standards and turnaround times.
  • Candidates must evaluate claims submitted by Third Party Administrators for compliance with underlying policy provisions and federal regulations.
  • The position requires analyzing client claim losses to control costs and providing counseling to support client service programs.

Matching Summary

The role involves reviewing and processing complex Stop Loss claims in accordance with established quality standards and turnaround times.

Salary

Base: $23.16 - $35.88 per hour; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • 5 years health insurance claims experience
  • 3 years first dollar claims processing
  • Medical terminology proficiency
  • Stop Loss claims analysis
  • Third Party Administrator (TPA) evaluation

Nice-to-have

  • Strong client relationship building skills
  • Effective time management abilities
  • Independent problem-solving capabilities
  • Experience with cost containment strategies

Key Requirements

  • High School Diploma or GED required
  • Bachelor's degree preferred
  • 5 years relevant progressive experience in health insurance claims
  • 3 years prior experience processing 1st dollar health insurance claims
  • 3 years experience with medical terminology

Work Rights

Not specified

Tailored Resume

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