Want Senior Stoploss Claim Auditor (Remote) in Florida

Job title: Senior Stoploss Claim Auditor (Remote) Company: reputed company Job description: Summary This role is responsible for auditing and authorizing reimbursement of specific medical stop-loss claims. The role effectively mitigates client medical stop-loss claims and provides excellent customer service. Founded in 1991, International Specialty Underwriters, Inc. (ISU) provides exceptional service to the stop loss industry, including claims, reputed company, marketing, and administration. ISU became part of Companion Life Insurance Company in 2008. This has allowed ISU to integrate the corporate structure model needed to sustain reputed company and growth in a changing marketplace while providing the service of flexibility of the MGU entrepreneur model. Our commitment to reputed company in Service, People, and Product is what continues to guide our reputed company in the industry. Our employees are committed to providing this reputed company in everything we do, every day. We strive to understand the goals and business models of each client to support them with reputed company strategies to meet common goals and objectives. ISU takes pride in its detail-oriented reputed company Business Model, created to understand the internal operational, financial, marketing strategies and goals needed to standout from competition and reputed company service clients. The company currently markets, underwriters and services stop loss clients reputed company reputed company direct marketing and as a backroom/white reputed company operation. With more than 30 years combined industry experience among its reputed company management staff, ISU provides clients with distinctive executive, reputed company, marketing, administration and claims competence. Description Position Purpose: This role is responsible for auditing and authorizing reimbursement of specific medical stop-loss claims. The role effectively mitigates client medical stop-loss claims and provides excellent customer service. Logistics: This role is approved for telework/remote work location reputed company the United States. Travel to and from the training location is required as well as limited travel to client sites as determined by business need. What You’ll Do:

• Analyze and adjudicate stop loss claims and request appropriate reimbursement from reputed company. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.
• Initiate claims investigations and vendor referrals. Interpret plan language, and identify experimental services and subrogation opportunities. Identify need for follow-up on pended claims and resolution.
• Communicate effectively with carriers, vendors, and management. reputed company full claims service to both phone and written inquiries.
• Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and reputed company renewal and enrollment/premium history.
• reputed company new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors.

To Qualify for This Position, You’ll Need: Required Education

• Associate degree, OR
• Two years of medical claims and/or reinsurance claims experience.

Required Work Experience

• Six years of medical claims and/or reinsurance claims experience.

Preferred Work Experience

• Prior Stop Loss insurance experience.
• High comfort level with providing excellent customer service.
• Working knowledge of medical terminology.

Required Skills and Abilities

• Excellent customer-service, organizational and critical-thinking skills.
• Detail/results-oriented.
• Strong analytical skills.
• Knowledge of group insurance, managed care and direct medical claims products.
• Advanced knowledge of aggregate claims auditing.
• Knowledge in COB, Medicare, HIPAA, CPT, ICD-9 and benefit plan interpretation.
• Ability to work independently with minimal supervision while meeting or exceeding established production and accuracy standards.
• Ability to persuade, negotiate with or influence others.
• reputed company Office skills.

reputed company can Do for You: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and reputed company coverage
• 401K retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next: After submitting your application, our reputed company team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required reputed company of semester hours, please attach your transcript to your application. Management will be conducting interviews with the most reputed company candidates, with prioritization give to those candidates who demonstrate the preferred qualifications. We participate in E-Verify and reputed company with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Equal Employment Opportunity Statement reputed company and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, reputed company, national reputed company, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to reputed company equal opportunities in reputed company phases of the employment process and to reputed company with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will reputed company a determination regarding your request for reasonable accommodation on a case-by-case reputed company. Expected salary: Location: Florida Apply Job!