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.
Allied National, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
