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Highmark Health

Creating remarkable health experiences, freeing people to be their best.

Senior Stop Loss Claims Analyst

Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 10,001+Since 1852H1B SponsorCompany SiteLinkedIn

Location

Louisiana + 4 moreAll locations: Louisiana | North Carolina | Maryland | Pennsylvania | Washington

Posted

75 days ago

Salary

$23 - $35 / hour

Seniority

Senior

High School5 yrs expEnglish

Job Description

Senior Stop Loss Claims Analyst

Highmark Health

• Review, evaluate, and process various Stop Loss claims in accordance with established standards • Build positive client relationships and provide education • Analyze client claim losses and current issues • Follow up on pended claims as per department standards • Process daily incoming Stop Loss claims • Evaluate claims for compliance with policy provisions and regulatory guidelines • Monitor and analyze complex claims and control losses through managed care • Finalize and adjudicate claims up to a pre-determined dollar threshold • Complete pended claim letters to TPAs or brokers • Identify discrepancies in claims submissions

Job Requirements

  • High School Diploma or GED required
  • 5+ years of relevant, progressive experience in health insurance claims
  • 3 years of prior experience processing 1st dollar health insurance claims
  • 3 years of experience with medical terminology
  • 3 years of experience in a Stop Loss Claims Analyst role preferred
  • Ability to communicate concise accurate information effectively
  • Organizational skills
  • Ability to manage time effectively
  • Ability to work independently
  • Problem Solving and analytical skills

Benefits

  • Health insurance
  • 401(k) matching
  • Flexible work hours
  • Paid time off
  • Remote work options

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