1 Stop Loss Claims Analyst Job in Rancho Cordova, CA

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Stop Loss Claims Analyst

HRtoGO/OmegaComp HR

Rancho Cordova, CA | Full Time

$64k-81k (estimate)

7 Months Ago

Stop Loss Claims Analyst

HRtoGO/OmegaComp HR Rancho Cordova, CA

$64k-81k (estimate)

Full Time 7 Months Ago

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HRtoGO/OmegaComp HR is Hiring a Stop Loss Claims Analyst Near Rancho Cordova, CA

Position Description:

Lucent Health, in Rancho Cordova, is seeking a Stop Loss Claims Analyst. The Stop Loss Claims Analyst is in daily contact with team members, providers, clients, brokers, and reinsurance carriers. A cheerful, competent and compassionate attitude will directly impact the productivity of the stop loss team and claims department. This position requires flexibility in duty assignments. Attendance and attitude are key as they can directly impact the satisfaction level of our clients and retention of our accounts.

Essential Duties and Responsibilities: include the following. Other duties may be assigned.

Processes claims accurately, efficiently and within production requirements as well as split claims for stop loss purposes.

Exhibits an attention to detail and a strong work ethic.

Exhibits the ability to access and utilize research tools for accurate claims entry.

Ability to read and understand contracts - Reinsurance contracts and Summary Plan Descriptions (SPD).

Possesses good organizational skills and can manage time and resources effectively and efficiently.

Possesses a thorough knowledge of coding structures (CPT, HCPCS, UB/Revenue codes, ICD 9/10 etc.)

Ability to perform arithmetic calculations.

Knowledgeable of Coordination of Benefits (COB).

Good understanding of benefits and benefit calculations.

Ability to handle all types of claims pricing (Network, Medicare, UCR, Reference Based Pricing, negotiations, etc.)

Performs duties in a HIPAA compliant manner.

Participates as a team member to ensure the smooth operation of the entire department.

Maintains guidelines and notes with detail to enable accurate claims examination.

Maintains Turnaround Time (TAT) guidelines and accuracy goals with filing of Aggregate and Specific stop loss claims.

Runs both monthly and renewal reports from BI as well as other reports to assist with both Aggregate and Specific stop loss filings.

Accurate and timely notifications of Trigger Diagnosis and 50% of specific deductible to stop loss carriers.

Reviews pre-authorizations for notification purposes.

Files stop loss claims - initial, subsequent and/or final filings, making sure all necessary documentation is included and submitted in a timely manner.

Reviews accuracy of claims included with reimbursement requests to prevent additional delay once the reinsurance claim has been received by the carrier.

Mails reimbursement checks to the clients including a cover letter explaining payment.

Maintenance of stop loss spreadsheets and stop loss files

Follows-up on any initial filings at 3 weeks and subsequent filings at 2 weeks including documentation on specific stop loss spreadsheet as to follow-up date and why reimbursement has not been received.

Develops and maintains relationships with the various brokers, carriers and contacts at the clients.

Responsible for aggregate audits.

Education and/or Experience: Bachelors degree (B.A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience. Knowledge of medical terminology, system hierarchies, medical coding, and claims processing.

Qualifications:

Detail-oriented with strong organizational skills.

Excellent telephone etiquette and interpersonal skills.

Excellent oral communication skills and written communication skills.

Strong skills in MS Word, Excel, and Outlook. Power Point Knowledge a plus.

Professional demeanor with ability to work in a fast paced environment.

Must also be able to work independently, multi-task, have excellent attention to detail, and be a team player.

Compensation: $20-31 per hour, DOE, plus full benefits, paid time off, holidays.