Stop Loss Claims Specialist
Company: VirtualVocations
Location: Concord
Posted on: April 1, 2025
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Job Description:
A company is looking for a Stop Loss Claims Specialist
responsible for reconciling documentation from third-party
administrators and adjudicating Aggregate Stop Loss Claims.
Key Responsibilities
Review Aggregate Claim Reports to determine potential refunds for
Policyholders and assist with subrogated matters
Adjudicate Monthly Aggregate Accommodation Requests in accordance
with Stop Loss Policy Provisions and internal protocols
Follow up with Third Party Administrators and Policyholders
regarding the status of information requests for pended claims
Required Qualifications
4+ years of experience in medical Stop Loss claims processing and
adjudication
Experience with third party administration, self-funding, and
reinsurance is required; aggregate claim experience preferred
Knowledge of CPT, ICD-10, and HCPCS codes, along with medical claim
practices
Proficiency in Microsoft Office applications, particularly Outlook,
Excel, and Word
Keywords: VirtualVocations, Concord , Stop Loss Claims Specialist, Other , Concord, California
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