Job ID: 49293
Location: Greenville, South Carolina
Employment Type: Direct Hire
Last Updated: 14 days ago
This opportunity offers hourly pay of $18-$20 per hour with great company benefits and PTO. Standard business hours, on-site, Monday through Friday.
Responsibilities:
- Processing and adjudicating stop loss claims submitted by self-funded employers or insurance companies. This involves reviewing the claims, determining their validity, and assessing whether they meet the criteria outlined in the stop loss policy.
- Conducting investigations into high-cost claims to ensure they are legitimate and accurate. This may involve reviewing medical records, consulting with healthcare providers, and analyzing claim documentation.
- Assessing whether claims fall within the parameters of the stop loss policy and determining the amount of reimbursement owed to the policyholder based on policy terms and conditions.
- Communicating with policyholders, brokers, healthcare providers, and other stakeholders regarding claim status, documentation requirements, and reimbursement processes.
- Maintaining accurate records of claims processed, including documentation of claim decisions, payments made, and any relevant correspondence. Generating reports on claims activity for internal analysis and reporting purposes.
- 3+ years of experience with medical claims processing and adjudication
- Experience with 3rd party administration, stop loss claims, excess loss claims, and aggregate claims preferred
- Knowledgeable about CPT, ICD-10, AND HCPCS codes
- Knowledgeable about medical claims including medical billing and coding preferred
- Proficient in Microsoft Office Suite
- Strong communication skills, both verbal and written
- Ability to work well with a team
- Ability to work in a fast-paced environment
- $18-$20 per hour
- 100% Employee health insurance covered
- 15 days of PTO
- 401k with company match
- Life Insurance
