Claims Analyst (Stop Loss)

Claims Analyst (Stop Loss)
Charleston, WV
Full-Time
Consumer Driven Services
Manager

Responsible for assisting the manager with daily operational activities relating to stop loss, including filings, follow up work on filings, and determination of advanced funded claims.

  1. High School graduate or equivalent;
  2. At least two years of experience in claims processing;
  3. Self-starter and works independently;
  4. Detail oriented  with good problem solving skills;
  5. Ability to prioritize and meet deadlines;
  6. Maintains confidentiality;
  7. Good communication skills;
  8. Proficient in Microsoft Office products (Word, Excel, Power Point);
  9. Easily adapts to changes in work requirements.

  1. Bachelor’s degree from an accredited college or university;
  2. Previous experience with claims processing and/or call center;
  3. Knowledge of stop loss;
  4. Knowledge of State and Federal regulations regarding claims payment guidelines;
  5. Five (5) years of experience in a claims processing environment with experience of all claims types;
  6. Familiar with client reports, member eobs, Databytes (BI reporting),  and assess the accuracy and validity of report data;
  7. Strong customer service background, written communication skills, motivation and initiative.

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org