Review and audit stop loss reimbursement requests to ensure accurate and timely payment in accordance with plan documents, stop loss policies, contractual requirements, and established procedures.
Evaluate supporting claim and eligibility documentation, perform aggregate claim calculations within delegated authority, and support plan-document review, payment integrity, reporting, and high-cost claim monitoring.
Retrieve, log, organize, and review stop loss claim submissions and supporting documentation within established turnaround standards.
Audit initial and supplemental reimbursement requests for eligibility, covered expenses, contract terms, deductible application, and other applicable plan and policy provisions.
Perform preliminary calculations and audits for aggregate accommodations and final year-end aggregate claim submissions, including review of contract terms, aggregate factors and deductibles, enrollment and premium information, paid claim data, and supporting documentation.
Requirements
Bachelor’s degree in Healthcare Administration, Accounting, Finance, Insurance, Business, or a related field
Auto damage claims adjuster serving as Progressive’s point of contact with customers, managing inventory, negotiating repair pricing, and assessing liability.
Compensation
$38.51 - $47.12/hour depending on experience
Responsibilities
Complete vehicle inspections, write estimates, determine total loss evaluations, and set clear expectations and timelines
Negotiate repair process with body shops
Document information related to the claim and make decisions consistent with claims standards and local laws
Evaluate and handle claim payments and resolution of claims without payments
Review and determine validity of any supplement requests
