Job Description

JOB TITLE: Stop Loss Claim Specialist

DEPARTMENT: Stop Loss Department

FLSA STATUS: Non-Exempt

JOB STATUS: FT

REPORTS TO: Sr. Manager, Stop Loss

WORK SCHEDULE: Flexible, during normal business hours, Monday-Friday.

ASSESSMENTS: PI Behavioral and Cognitive Assessments

POSITION SUMMARY:

The Stop Loss Claim Specialist is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers. Additional duties include following up with the various carriers to ensure reimbursements are received timely and in full. Further responsibilities include the appeals of denied and reduced claim reimbursements, along with retaining the appropriate documentation needed to support the reimbursement request.

ESSENTIAL FUNCTIONS:

• Compile and submit claim reports and the necessary documentation to file a stop loss claim.
• Monitor the status of claims assigned and follow up with stop loss carriers.
• Answer questions and requests from stop loss carriers for additional information.
• Communicate with other internal departments to resolve claim issues.
• Appeal the denials or reduction of reimbursements by the stop loss carrier.

POSITION QUALIFICATIONS:

Communication Communicates effectively both internally and externally, where applicable. Includes both written and verbal communication.

Dependability Meets deadlines, works independently, accountable, maintains focus, punctual, and maintains good attendance record.

Initiative Takes action independently, seeks new opportunities, and strives to see projects to completion.

Interpersonal Skills Builds strong relationships, is flexible/adaptable, works well with others, and solicits feedback.

Job Knowledge Understands the facets of job, aware of duties and responsibilities, and keeps job knowledge current.

Organization Skills Information organized and accessible maintains efficient work space, and manages time well.

Problem Solving Strives to understand contributing factors, works to resolve complex situations.

Productivity Manages workload, works efficiently, and meets goals and objectives.

Quality Strives to eliminate errors, accurate work is a priority, seeks opportunities to improve product/services

Self-Development Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals and/or maintains licenses and other pertinent requirements.

Teamwork Accountable to team, works to meet established deliverables, appreciates view of team members, and respectful.

Technical Skills Maintains current understanding of technical process/equipment, uses technology to increase performance/productivity; effectively uses online tools and resources.

SKILLS & ABILITIES:

Applicant must be highly proficient in the use of Microsoft Word, Excel, and Outlook and must have the ability to easily learn new computer applications.

EDUCATION:

Bachelors degree or related experience preferred.

EXPERIENCE:

Medical claims experience preferred; accounting background a plus.

PHYSICAL DEMANDS:

None

WORK ENVIRONMENT:

Modern office suite in high rise building in downtown Chicago.