Specific Stop Loss Claims Auditor

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

Brown & Brown is seeking a Specific Stop Loss Claims Auditor to join our growing team.

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.

How You Will Contribute

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 and summary plan description.

Accurately apply all deductibles, coinsurances, aggregating specific deductibles and lasers.

Provide customer service for MGU partners and their respective TPAs.

Conduct timely follow up on all pended claims.

Contribute innovative ideas and assist with the implementation of new processes.

Skills & Experience to be Successful

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.

claims, HMO reinsurance and/or provider excess claims.

Prior experience with industry repricing methodologies. (PPO, Wrap Networks, Reference Based Pricing,etc.).

Demonstrated proficiency in Microsoft Office, including Microsoft Outlook.

Demonstrated strong analytical/critical thinking skills; and detail‐oriented focus.

Strong written and verbal communication skills.

Ability to work independently with minimal supervision.

Preferred

Prior experience auditing managed care or specific/aggregate stop loss claims.

History of successful Process Improvement initiatives.

Pay Range

75,000.00 - 90,000.00 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.

Teammate Benefits & Total Well-Being

We go beyond standard benefits, focusing on the total well-being of our teammates, including:

Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance

Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement

Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services

Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more.

Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.

Recruiting Vendor Disclosure Statement

Brown & Brown does not accept unsolicited resumes from external recruiters, recruitment vendors or employment agencies ("Recruiting Vendors"). Recruiting Vendors must have a valid written agreement and received prior written authorization from an authorized Brown & Brown representative before submitting candidates for any publicly posted role.

Any unsolicited resumes submitted to Brown & Brown or its employees become the property of Brown & Brown, and no fees will be paid for such submissions. Additional information regarding this policy can be found on our careers page.

The Power To Be Yourself

As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

Originally posted on Himalayas