Description: Allied is excited to announce that we are looking for a Stop Loss Claims Specialist to join our team! This person will be responsible for identifying, tracking, reviewing, and processing stop-loss reimbursements claims on behalf of carriers within an MGU stop-loss operation. An ideal candidate brings strong knowledge of medical claims, stop-loss policy interpretation, and large-claim management in a self-funded or TPA environment. Duties/Responsibilities Review and process specific and aggregate stop-loss claims in accordance with policy provisions, carrier guidelines, and internal procedures Interpret stop-loss contracts and supporting plan documents to determine reimbursement eligibility, required documentation, and claim disposition Monitor high-cost and ongoing claims for reimbursement potential and follow up on outstanding submissions or requests for additional information Prepare, track, and report specific and aggregate claim activity, including aggregate accommodation calculations, monthly reporting, and audit support Analyze claims, medical documentation, and supplemental materials to ensure timely, accurate claim handling and clear audit trails Requirements: Must have a high school diploma or equivalent. Associate or Bachelors in a related field is a plus.Needs to have 3+ years of experience in medical claims processing, stop-loss administration, aggregate claim review and processing, large claim review, or a related self-funded environmentMust be able to read, interpret, and apply stop-loss contracts, policy language, and supporting plan documentsPIe8a99529d55d-2491
Not specified in the original listing.
Not specified in the original listing.
