South Windsor, Connecticut
Stoploss Auditor Job Opening in South Windsor, Connecticut - Job Title
Sr. Stoploss Auditor
Seeking a Stop Loss Claims Auditor with knowledge of group insurance, managed care and direct medical claims products. Must have excellent customer service, organizational and critical thinking skills.
Primary Responsibilities
Audit specific and aggregate claims for assigned complex blocks of business.
Audit and process claim reimbursements on behalf of the Carrier/Re-Insurer.
Verify that claims are paid in accordance with the Plan Document.
Verify participant and dependent eligibility.
Maintain and exceeds targeted claims accuracy standards.
Recover overpaid claims through refund request.
Maintain accurate and detailed information for each file.
schedule implementation calls for newly sold groups.
Technical Skills
Basic computer skills using MS Office (Outlook, Excel, MS Word).
Experience/Skills Needed
3 years or more experience with examining and auditing medical stop loss specific and aggregate claims.
Knowledge of reinsurance contracts, health benefits and group health plans.
Interested candidates should contact Donna Carter at
Who We Are
Medical Risk Managers (MRM) is a full service Managing General Underwriting and Consulting firm specializing in Group Stop Loss insurance . Our mission is to provide reliable protection against excessive medical claims. We accomplish this through the use of innovative products, customized services to fit your specific insurance needs, and through extensive network evaluation and consulting. We realize that achieving success in the rapidly evolving world of health care requires insight, knowledge, and the ability to adapt to constantly changing market conditions.
Job Type: Full-time
Salary: $40,000.00 /year
Required education:
Bachelor's
Required experience:
medical claims processing: 3 years
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