Claims Examiner, Medical Stop Loss
Job Description:
- Within documented authority levels, review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and Policies
- Clearly and professionally communicate external requests for information and maintain timely follow-up
- Clearly and professionally communicate claim payment and denial decisions
- Confirm appropriate disclosure when applicable
- Calculate and maintain reserves as needed
- Assist with aggregate accommodation activities and aggregate claim submissions
- Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility
- Assist with refining internal claim procedures and recommending improvements to management
- Other duties as assigned
Requirements:
- 3+ years medical stop loss claim experience required
- Bachelor’s degree or equivalent experience required
- Strong working knowledge of both Microsoft Office suite with an aptitude to learn new programs (ESL Office experience preferred)
- Ability to establish a good rapport with all stakeholders
- Commitment to delivering outstanding customer service and satisfaction
- Commitment to exploring and assisting in implementing new processes to increase effectiveness and achieve organizational goals
- Exceptional attention to detail and accuracy
- Capability to manage multiple priorities in a fast-paced environment
- Excellent written and verbal communication skills
Benefits:
- Competitive compensation package
- Generous 401K employer match
- Employee Stock Purchase plan with employer matching
- Generous Paid Time Off
- Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing
- A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
- A dynamic, ambitious, fun and exciting work environment
- We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community
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