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Specific Stop Loss Specialist at National Healthcare Solutions, Inc.

, , United States -

Full Time

Start Date

Immediate

Expiry Date

06 Feb, 26

Salary

0.0

Posted On

08 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Research, Documentation, Communication, Organization, Microsoft Word, Microsoft Excel, Microsoft Outlook, Healthcare Knowledge, Stop Loss Insurance Knowledge, Flexibility, Professionalism, Written Communication, Verbal Communication

Industry

Insurance

Description

The Specific Stop Loss Specialist (SLSS) plays a critical role in managing Specific Reimbursements and Advance Funding processes 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. Key Responsibilities: * Coordinate and file Specific Reimbursements and Advance Funding requests. * Conduct detailed research using claims data to support reimbursement processes and payments. * 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 * Monitor claims email box for large dollar claims that will affect Stop Loss * Assist with other administrative tasks as needed Required Skills: * Intermediate level computer skills, including Microsoft Word, Excel, and Outlook * A high school diploma or GED certificate * At least 3 years' experience as a claims examiner processing first dollar medical claims * Stop loss insurance knowledge a plus * 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 Specific Stop Loss Specialist coordinates and files Specific Reimbursements and Advance Funding requests while conducting detailed research using claims data. They maintain professional communication with internal teams, vendors, and clients, ensuring compliance and timely management of claims.