Senior Stoploss Claim Auditor (Remote)

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, underwriting, 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 success and growth in a changing marketplace while providing the service of flexibility of the MGU entrepreneur model.

Our commitment to Excellence in Service, People, and Product is what continues to guide our success in the industry. Our employees are committed to providing this excellence in everything we do, every day. We strive to understand the goals and business models of each client to support them with parallel strategies to meet common goals and objectives.

ISU takes pride in its detail-oriented Carrier Business Model, created to understand the internal operational, financial, marketing strategies and goals needed to standout from competition and better service clients. The company currently markets, underwriters and services stop loss clients nationwide via direct marketing and as a backroom/white paper operation.

With more than 30 years combined industry experience among its elite management staff, ISU provides clients with distinctive executive, underwriting, 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 within 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

• Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history.
• Communicate effectively with carriers, vendors, and management. Provide full claims service to both phone and written inquiries.
• 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.
• Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors.
• Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits.

Required Education

To Qualify for This Position, You’ll Need:

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

Required Work Experience

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

Preferred Work Experience

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

Required Skills And Abilities

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

What We 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.

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

What To Expect Next

After submitting your application, our recruiting 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 proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, 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 provide equal opportunities in all phases of the employment process and to comply 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 make a determination regarding your request for reasonable accommodation on a case-by-case basis.