Stop Loss Analyst

Job Details: Job Location: Corporate Austin

• Austin, TX, Salary Range: $20.00 - $26.00Hourly, Job Responsibilities This position works as part of the Stop Loss Team to ensure timely reporting and stop loss claim filing with the various stop loss carriers. Monitors members approaching/exceeding spec, including policies with advance funding. Monitors clients approaching/exceeding aggregate, including policies with accommodation. Generates various reporting and reviews for accuracy before distribution, both internally and externally, as assigned. Gathers supporting documentation from both internal and external entities. Compiles stop loss claim filings, to include all supporting information/documentation, and submits to the stop loss carrier to maximize reimbursement. Manages filings, through reimbursement, to include consideration of policy filing limitations. Communicates regularly with various departments, external vendors, clients, and carriers. Validates filing denials and appeals when necessary, to ensure our clients are receiving the maximum reimbursement allowed under the policy.

Qualifications

High school diploma or equivalent. 2 years of experience in stop-loss claims and/or auditing would be preferable but would substitute additional experience processing medical claims. Experience with various specific and aggregate policy contracts preferred. Ability to analyze detailed reports and validate accuracy of the data.

Experience in Microsoft Outlook, Word and Excel. Time management skills and the ability to adhere to deadlines. Good verbal and written communication skills. Ability to maintain regular attendance. Ability to maintain confidentiality of material and information. Ability to maintain professional appearance and demeanor.

Ability to work independently with minimal supervision. Demonstrate problem-solving and decision-making skills and be adaptable in a changing environment