Claims Specialist resolving customer claims related to pricing, quality, and transport issues. Joining Newell Brands for a dynamic hybrid role in Prague.
About the role
- Senior Stop Loss Claims Analyst at Highmark Health, evaluating and processing insurance claims while building client relationships and ensuring compliance. Responsible for daily claims processing, client support, and maintaining accurate records.
Responsibilities
- Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed
- Provides counseling to clients and assists with client service programs
- Evaluates various claims submitted by Third Party Administrators (TPAs) for compliance with underlying policy provisions, federal and state regulatory guidelines, and industry standards
- Monitors, reviews and analyzes various complex potential claims
- Determines whether to pend or adjudicate claims following organizational policies and procedures
- Completes pended claim letters for incomplete, invalid, or missing claim information
- Identifies potential discrepancies in claim submissions
- Assists leadership with performing client performance evaluations
- Maintains accurate claim records
Requirements
- High School Diploma/GED
- 5 years of relevant, progressive experience in health insurance claims
- 3 years of prior experience processing 1st dollar health insurance claims
- 3 years of experience with medical terminology
- 3 years of experience in a Stop Loss Claims Analyst role (preferred)
- Ability to communicate concise accurate information effectively
- Organizational skills
- Ability to manage time effectively
- Ability to work independently
- Problem Solving and analytical skills
Benefits
- Health insurance
- Flexible work arrangements
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