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Stop Loss Data Specialist

Remote: 
Full Remote
Contract: 
Full time
Experience: 
Junior (1-2 years)
Work from: 
United States

Offer summary

Qualifications:

Bachelor’s degree or equivalent experience, 1-2 years of office experience, Medical claims experience preferred, Accounting or finance background a plus, Experience with TPA or insurance company a plus.

Key responsabilities:

  • Audit and track stop loss claim filings
  • Manage stop loss tracking and logs
  • Review and record stop loss reimbursements
  • Gather data for Rx stop loss claims
  • Oversee the cash advance process
Allied Benefit Systems, LLC logo
Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/
501 - 1000 Employees
About Allied Benefit Systems, LLC
Allied is a national healthcare solutions company that works with organizations who choose to take control of their healthcare. We customize employer self-insurance benefits to align with individual choice and organizational need while integrating medical management innovations and cost-control strategies. With healthcare designed for people, employers never have to choose between price and the best-fit insurance products to protect employees and their families. Allied’s philosophy is to create a culture of health for our member organizations and their employees beyond simple, medical health. We integrate administrative services, care solutions and analytics to achieve better clinical, behavioral and social patient outcomes. Allied’s programs and benefit services are designed and structured to infuse value on every front – for employers and HR departments, for plan members and their families, for healthcare providers, and for us. We’re in this together, committed to your future.
See more Allied Benefit Systems, LLC offers

Job description

STOP LOSS DATA SPECIALIST

POSITION SUMMARY:

The Stop Loss Data Specialist is responsible for auditing and tracking stop loss claim filings, reimbursements, and cash advance claims to ensure the department is running in an efficient and thorough manner. The Analyst also works closely with Stop Loss Claim Specialist on administrative, organizational, and auditing functions.

ESSENTIAL FUNCTIONS:

  • Perform monthly audits to ensure all stop loss claims have been filed and all reimbursements have been received.
  • Update and manage the stop loss tracking and specific logs to monitor the current status of members over the specific deductible.
  • Review and accurately record stop loss reimbursements.
  • Gather and prepare the data required to file Rx stop loss claims.
  • Request and track Actively at Work forms from Clients
  • Manage the cash advance process. This includes determining which claims to pull for cash advance and mailing out the appropriate cash advance checks when reimbursements are received.
  • Other duties as assigned

REQUIRED SKILLS AND ABILITIES:

  • Excellent organizational skills and attention to detail.
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Proficient with Microsoft Office Suite or related software.
  • Excellent time management skills with a proven ability to meet deadlines.
  • Ability to function well in a high-paced and at times stressful environment.

EDUCATION AND EXPERIENCE:

  • Bachelor’s degree or equivalent work experience
  • 1-2 years of experience in an office environment required
  • Medical claims experience preferred
  • Accounting or finance background a plus
  • Experience working with a TPA or other insurance company a plus

COMPETENCIES:

  • Communication
  • Customer Focus
  • Accountability
  • Functional/Technical Job Skills

PHYSICAL DEMANDS:

Ability to sit for long periods of time. Ability to communicate via telephone.

WORK ENVIRONMENT:

Remote

Required profile

Experience

Level of experience: Junior (1-2 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

Medical Insurance ClaimsFinanceAccountingOnline CommunicationInsurance Sales

Other Skills

  • Detail Oriented
  • Motivational Skills
  • Organizational Skills
  • Non-Verbal Communication
  • Microsoft Office
  • Analytical Skills
  • Time Management
Are you interested?

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