Stop Loss Accounting Analyst
About The Position
Summary Responsible for submitting stop loss claim packets and responding to any requests for additional information. Additionally, the claims must be tracked and monitored. Complex analysis is performed and queries are generated to file and validate the claim submissions. Description Logistics: This position is full time (40 hours/week) Monday-Friday, with typical work hours 8:00 am – 4:30 pm onsite at 4101 Percival Rd., Columbia, SC. What You Will Do: Prepares and files 50% and 100% stop loss claim packets. Run queries, compiles eligibility data and submits claim packet. Audits stop loss positions by running queries and comparing to the accumulated claims in the billing system. Researches variances, document discrepancies and make appropriate adjustments. Responds to audit letters. Works with other areas including claims, marketing and managed care to obtain requested information. Tracks claims packet filing and MGU responses. Logs all submissions, audit letters receipts and responses in the tracking database/log. Provides manual monitoring of special stop loss scenarios including carved out pharmacy. Ensures the member's stop loss positions are properly tracked and updated. Performs complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions. Creates custom reports and spreadsheets based on customer inquiries.
Requirements
- Required Education: Bachelor's in a job related field Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
- Required Work Experience: 3 years in accounting, auditing, billing, claims, membership, or finance.
- Required Skills and Abilities: Ability to compile information, perform research and analyze data.
- Strong customer service and organizational skills.
- Excellent verbal and written communication skills.
- Ability to take initiative and meet deadlines.
- Attention to detail.
- Required Software and Tools: Microsoft Office including Access
Nice To Haves
- Preferred Work Experience: Experience within a self-funded insurance programs, and working Excel knowledge.
- Preferred Software and Other Tools: Experience with AMMS claims processing system, experience with PFAB claims billing system, DB2 experience.
Responsibilities
- Prepares and files 50% and 100% stop loss claim packets.
- Run queries, compiles eligibility data and submits claim packet.
- Audits stop loss positions by running queries and comparing to the accumulated claims in the billing system.
- Researches variances, document discrepancies and make appropriate adjustments.
- Responds to audit letters.
- Works with other areas including claims, marketing and managed care to obtain requested information.
- Tracks claims packet filing and MGU responses.
- Logs all submissions, audit letters receipts and responses in the tracking database/log.
- Provides manual monitoring of special stop loss scenarios including carved out pharmacy.
- Ensures the member's stop loss positions are properly tracked and updated.
- Performs complex reviews of claims data in situations where the stop loss system does not accurately accumulate stop loss positions.
- Creates custom reports and spreadsheets based on customer inquiries.
Benefits
- 401(k) retirement savings plan with company match.
- Subsidized health plans and free vision coverage.
- Life insurance.
- Paid annual leave – the longer you work here, the more you earn.
- Nine paid holidays.
- On-site cafeterias and fitness centers in major locations.
- Wellness programs and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Incentive Plan.
- Merit Plan.
- Continuing education funds for additional certifications and certification renewal.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
