Claims Analyst – Stop Loss Insurance Position Available In Capitol Planning Region, Connecticut

Claims Analyst – Stop Loss Insurance Medical Risk Managers East Hartford, CT 06108 • Hybrid work Overview This position is responsible for examining, auditing and rendering a decision concerning liability of claims made under the Medical Stop Loss policies that the Company has issued to existing clients. Make recommendations and decisions concerning the validity of claims presented, to reimburse, reject or secure additional information until that decision can be made. Responsibilities Audit specific claims for assigned clients. Review and approve Plan Documents Audit and process claim reimbursements on behalf of the Carrier/Re-Insurer Verify that claims are paid in accordance with the Plan Document and Stop Loss Policy Review all requests for reimbursement: o Verify participant and dependent eligibility o Maintain accurate and detailed information for each file o Review high-cost claims relative to financial and coding accuracy and coordination with Cost Containment programs Maintain and exceed targeted claims accuracy standards Meet and exceed targeted turnaround time for all submissions and pending claims Recover overpaid claims through refund request Maintain positive and professional working relationship with peers and clients Complete, track and follow up for the TPA approval process Cross training with the rating team, as time warrants, the Claims team takes precedent Skills / Experience Stop loss Insurance Background required, at least 3 years Basic computer skills using MS Office (Outlook, Excel, MS Word) Intermediate level experience performing data entry functions Experience/Skills Needed Knowledge of Medical Terminology (ICD10, HCPCS and CPT4 codes) Experience with examining and auditing medical stop loss specific claims Claims experience of Stop Loss claims or first dollar medical claims Knowledge of Plan Documents, Stop Loss Policies and reinsurance contracts Excellent interpersonal, oral and written communication skills Telephone Etiquette Ability to work independently as well as with a team Must be detailed oriented Good organization and time management skills

Job Type:

Full-time Pay:

From $60,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible schedule Flexible spending account Health insurance Life insurance Matching gift program Paid time off Referral program Retirement plan Tuition reimbursement Vision insurance Work from home

Schedule:

Monday to

Friday Overtime Work Location:

Hybrid remote in East Hartford, CT 06108