Senior Stop Loss Claims Auditor

Auditing and authorizing reimbursement of specific medical stop loss claims, the full-time Senior Stop Loss Claims Auditor will work remotely to mitigate client claims and provide exceptional customer service. Key responsibilities Analyze and adjudicate stop loss claims, authorizing reimbursement checks within pre-set limits Initiate claims investigations, interpret plan language, and identify subrogation opportunities Communicate effectively with carriers and vendors, providing comprehensive claims service for inquiries Required qualifications Associate's degree or equivalent work experience (2 years of job-related experience) 6 years of managed care or reinsurance claims experience Experience analyzing laws, regulations, and contract language Ability to handle confidential and sensitive information Experience in investigating claims and proposing adjustments or refunds