Stop Loss Claims Analyst

Job Summary

A company is looking for a Claims Analyst.

Key Responsibilities

• Process an average of 5 to 7 claims per day while maintaining a processing accuracy of 99% or better
• Determine eligibility of assigned claims by applying appropriate contractual provisions to medical facts
• Document rationale for claim decisions and elevate issues to supervision as needed

Required Qualifications

• 3-5+ years of stop loss claims experience
• Prior experience handling first dollar payer insurance (medical healthcare claims)
• Experience with medical billing practices, CPT codes, and revenue codes
• Ability to use mathematics for adjudicating claims
• Demonstrated proficiency in Microsoft Office software