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Form of work
SalaryPrimary Responsibilities and Duties:
- Analyze Specific Stop Loss claims.
- Identify and isolate the data that is specific to a particular claim submission.
- Validate which expenses are eligible under the Stop Loss policy.
- Accurately apply all deductibles, coinsurances, aggregating specific deductibles and lasers.
- Conduct timely follow up on all pended claims.
- Contribute innovative ideas and assist with the implementation of new processes.
Requirements and Qualifications:
- Must have Excel Proficiency to include knowledge of basic formulae, sorting techniques and PIVOT Tables.
- Minimum 2 years Claims experience with first dollar medical claims, specific and/or aggregate claims, HMO reinsurance and/or provider excess claims.
- Prior experience with industry repricing methodologies. (PPO, Wrap Networks, Reference Based Pricing etc.).
- Prior experience auditing managed care or specific/aggregate Stop Loss claims preferred.
- History of successful Process Improvement initiatives preferred.
Corporate Benefit Audits, Inc. (CBA), a division of Risk Strategies Company, headquartered in North Andover, MA since 1992, has provided audit services to Carriers, MGU’s, Reinsurers and Employer clients managing healthcare risk and associated Stop Loss Reinsurance concerns. The incumbent is responsible for providing Specific Stop Loss claims auditing services for MGU and/or Carrier clients.
At Risk Strategies Company, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, and life insurance, retirement savings, and paid time off and paid holidays for eligible employees. The total compensation for a position may also include other elements dependent on the position offered. The expected base pay range for this position is between $19.24 - $33.65 per hour. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience.
Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, Risk Strategies serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and nearly 5,000 employees across the US and Canada.
Our industry recognition includes being named a Best Places to Work in Insurance for the past five years (2018-2022) and on the Inc. 5000 list as one of America’s Fastest Growing Private Companies. We are committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues.
Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page:
www.risk-strategies.com/careers
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