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Aggregate Stop Loss Specialist at National Healthcare Solutions, Inc.

, , United States -

Full Time

Start Date

Immediate

Expiry Date

20 Apr, 26

Salary

0.0

Posted On

20 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Aggregate Reporting, Research, Documentation, Communication, Organization, Excel, Microsoft Word, Outlook, Stop Loss Insurance, Healthcare Industry Knowledge, Audit Response, Deadline Management, Administrative Tasks

Industry

Insurance

Description

POSITION SUMMARY The Aggregate Stop Loss Specialist (ALSS) plays a critical role in managing Aggregate reporting and filings for self-funded and level-funded clients. This position requires a strong grasp of claims processing to conduct effective informational research and ensure accurate coordination and filing. ESSENTIAL DUTIES AND RESPONSIBILITIES * Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests * Conduct detailed research using claims data to support reimbursement processes and payments * Respond promptly and thoroughly to audit requests by gathering (or directing appropriate parties) to gather the requested information for pre-audit work; review all information being sent out for accuracy and appropriateness * Documentation of authorizations and/or denials by the stop loss carriers * Maintain professional communication with internal teams, vendors and clients * Operate independently while meeting deadlines and compliance standards * Manage and track the received, pended and completed claim files * Document escalations and/or authorizations for release of claim payments * Assist with other administrative tasks as needed MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES) * Intermediate level computer skills, including Microsoft Word, and Outlook * Advanced Excel required * A high school diploma or GED certificate * At least 3 years' experience as a claim’s examiner processing first dollar medical claims * Stop loss insurance knowledge required * Overall knowledge of Healthcare industry * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Strong communication and organizational skills * Excellent written and verbal communication skills

Responsibilities

The Aggregate Stop Loss Specialist coordinates and files Aggregate Reimbursements and Monthly Accommodation requests while conducting detailed research using claims data. They also respond to audit requests and maintain communication with internal teams, vendors, and clients.