Trainer Stop Loss Claims
$80,000–$100,000 year
RemoteUnited States
Job Summary
Develop a training curriculum and materials for Specific Stop Loss claims auditors, covering logging, data entry, claim checklists, and payment processing. Establish objective measuring tools to track trainee progress and assess readiness for production placement. Serve as a subject matter expert providing technical guidance to the claims team, while reviewing and analyzing referred claims to assist with over-authorization reviews. Audit Specific Stop Loss claims during peak periods and contribute innovative ideas to implement continuous process improvements. Requires 3-5 years of Specific Stop Loss Claim experience, prior team lead or management experience, and proficiency in Microsoft Office. Salary range $80,000 - $100,000 annually.
Required Qualifications
- 3-5 years of Specific Stop Loss Claim experience
- Prior Team Lead or Management experience in stop loss claims to include experience with quality assurance
- 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
- Detail-oriented focus
- Strong written and verbal communication skills
- Ability to work independently with minimal supervision
Desired Qualifications
- Prior experience auditing aggregate stop loss claims
- History of successful Process Improvement initiatives
- Prior experience leading a team or managing processes
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