- Remote, United States +1 more
- Remote
- 3+ years
Locations (2)
- Phoenix, Arizona, United States
- United States
Responsibilities
- 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.