Stop Loss Claims Specialist II-Specific

POSITION SUMMARY

The Stop Loss Claim Specialist II (Specific) is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers for individual stop loss (Specific) coverage. 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. The Stop Loss Claim Specialist II will be responsible for training team members. In addition, duties will include maintaining a relationship with priority carriers.

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.
• Filing Stop Loss Claims with priority carriers.
• Coordinating with other Stop Loss Team Members regarding priority claims.
• Filing high dollar claims.
• Retain necessary documents required by carriers from providers.
• Training team members regarding departmental process and workflows.
• Other duties as assigned.

EDUCATION

• High School Diploma or GED required. 
• College degree preferred.

EXPERIENCE AND SKILLS

• Minimum 2 years of stop loss claim filing experience, required.
• Medical claims experience required.
• Accounting or Finance background a plus.
• Proficient with Microsoft Office Suite or related software.
• Strong analytical and problem solving skills.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.

POSITION COMPETENCIES

• Accountability
• Communication
• Customer Service Orientation
• Functional/Technical Skills
• Quality Focus
• Time and Task Management

PHYSICAL DEMANDS 

• This is a standard desk role requiring extended sitting and computer work. 

WORK ENVIRONMENT

• Remote 

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.