* Analyzing medical stop-loss claims and determining eligibility of coverage and benefits
* Drafting requests to Claims Administrators for additional information as needed
* Reviewing files on a consistent basis to determine appropriate follow-up actions to be taken
* Adjudicating claims according to plan and policy provisions
* Generating payment requests timely and accurately
* Creating and maintaining online records of charges
* Establishing, monitoring, and adjusting reserves
* Responding to written inquiries and engaging with underwriting as needed
* Entering aggregate claims data and adjudicating aggregate claims * Managing medical stop-loss claims team
Requirements
* Bachelor's degree
* Minimum of 5 years of claims handling experience
* Deep familiarity with medical stop-loss coverage
* Experience with appeals and complex claims
* Knowledge of healthcare terminology and pricing
* Strong analytical, writing, and communication skills
* Ability to work well independently and within a team
* Hold, or be willing to obtain adjuster licenses