Stop Loss Claims Adjuster

Our client in Greenville, SC is seeking an experienced Stop Loss Claims Specialist. The ideal candidate will be experienced in handling stop loss insurance and processing reimbursements for Stop Loss or Aggregate claims.
This opportunity offer a salary of $42-52,000 with great company benefits and PTO. Standard business hours, on-site, Monday through Friday.
Responsibilities: Processing and adjudicating stop loss claims submitted by self-funded employers or insurance companies. This involves reviewing the claims, determining their validity, and assessing whether they meet the criteria outlined in the stop loss policy.Conducting investigations into high-cost claims to ensure they are legitimate and accurate. This may involve reviewing medical records, consulting with healthcare providers, and analyzing claim documentation.Assessing whether claims fall within the parameters of the stop loss policy and determining the amount of reimbursement owed to the policyholder based on policy terms and conditions.Communicating with policyholders, brokers, healthcare providers, and other stakeholders regarding claim status, documentation requirements, and reimbursement processes.Maintaining accurate records of claims processed, including documentation of claim decisions, payments made, and any relevant correspondence. Generating reports on claims activity for internal analysis and reporting purposes.Qualifications: 3+ years of experience with medical claims processing and adjudicationExperience with 3rd party administration, stop loss claims, excess loss claims, and aggregate claims preferredKnowledgeable about CPT, ICD-10, AND HCPCS codesKnowledgeable about medical claims including medical billing and coding preferredProficient in Microsoft Office SuiteStrong communication skills, both verbal and writtenAbility to work well with a teamAbility to work in a fast-paced environmentCompensation: $42,000-52,000Employee health insurance covered15 days of PTO401k with company matchLife Insurance