Job Summary
The Stop Loss Claims Specialist plays a crucial role in an MGU operation by ensuring the effective identification, tracking, and processing of stop-loss reimbursement claims. This position requires the interpretation of intricate contract stipulations and the monitoring of high-cost claims to guarantee precise reimbursements and adherence to carrier regulations.
Responsibilities
- Identify and process stop-loss reimbursement claims accurately.
- Track the progress of high-cost claims to ensure timely reimbursement.
- Interpret and analyze complex contracts related to stop-loss administration.
- Verify compliance with established carrier guidelines throughout the claims process.
Qualifications
- Minimum of 3 years of experience in medical claims processing or stop-loss administration.
- A high school diploma is mandatory; an associate or bachelor’s degree is a valuable advantage.
