Healthcare Claims Adjuster- Stop Loss

Founded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees.

Role Description

We are seeking a detail-oriented Medical Stop Loss Adjuster to join our team. In this role, you will be responsible for evaluating and processing stop loss claims to ensure accurate and timely payments. You will assess claim validity, verify coverage, and determine appropriate reimbursement. The ideal candidate will have a strong understanding of medical terminology, insurance policies, and claims processing, along with excellent analytical and communication skills. This role requires a commitment to maintaining high standards of accuracy and efficiency in a fast-paced environment.

Key Duties & Responsibilities:

• Review and audit claims submissions within authority level for accuracy and completeness and determine appropriate reimbursement.
• Timely process claims in an accurate manner, communicate with third-party administrators, and ensure proper cost containment.
• Manage inventory of pended claims according to department metrics.
• Maintain appropriate reserve records on claims.
• Actively participate in team meetings and training.
  
  
  

Skills and Qualifications:

• Knowledge of Health Care services, policies, procedures and systems.
• 3 years of experience with intake of Medical, Dental, Vision claims
• Certified in Medical Terminology I, II and ICD9/10 knowledge
• Precise attention to detail
• Excellent verbal communication, collaboration, and written skills
• Strong organizational and time management skills; handles multiple workstreams with deadlines simultaneously
• Proficiency in Microsoft Office (Word, Excel);
• Proficiency in claims administration systems such as Javelina, ESL or similar.
  
  
  

Better Benefits:

We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:

• Medical, dental and vision benefits
• Annual bonus
• Parental Leave
• Dependent care 100% match up to max allowable
• PTO beginning on Day 1
• Tuition reimbursement
• Health work/life balance
• Hybrid office schedule
• 401(k) plan with company match
• Employee Assistance Program
• On-site gym with personal trainer access
• Life insurance and short term disability insurance
  
  
  

More About Roundstone

Headquartered in Rocky River, Ohio, Roundstone is proud to be a Northeast Ohio Top Workplace as recognized by The Plain Dealer and cleveland.com, based on anonymous employee feedback. We foster a supportive, values-driven culture where employees feel engaged, valued, and celebrated. Roundstone has also been named an Inc. 5000 award recipient for eight consecutive years, reflecting our continued growth and success.

Our Core Values

• Live well: Be healthier and bring positive energy to all you do.
• Work smarter: Get things done, better.
• Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
• Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.
  
  
  

Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:

https://go.cultureindex.com/p/f3eNpwni6hi

Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.