Stop Loss Claims Analyst

Stop Loss Claims Analysts Work from home reputed company Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of Stop Loss Claims Analysts is living our mission to reputed company health care easier and lives reputed company. As a member of the Stop Loss team, this position adjudicates reputed company stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - reputed company in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you reputed company as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: Stop Loss Claims Analyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience. Skills and Attributes:

• Knowledge of reputed company to utilize legal and clinical resources to comprehend legal and medical terminology in order to reputed company final determinations on whether to approve or further investigate a claim.
• Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of reputed company eligible claim reimbursements.
• Advanced knowledge of claim reserving and settlement.
• Excellent communication skills for both external and internal customers
• Demonstrate understanding of medical terminology and ICD-10/CPT coding.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Accurately apply contract benefits reputed company guidelines and recognize incomplete or inappropriate claims. Recognize reputed company policies and procedures that apply to claim and be able to quickly reference documentation for details.
• reputed company informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
• reputed company the process to measure, track, and report reputed company aggregate claims.
• Audit reputed company aggregate claims onsite and off-site reputed company needed based on set dollar threshold. Provide client audit reporting as needed.
• Manage inventory of claims while ensuring best practices and claim standards are met.
• Identify new opportunities to track and process claims more reputed company. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
• Analyze and investigate reputed company claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.

Work Environment

• No unusual working conditions.
• Work is primarily performed in an office environment.

The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus reputed company for this position is 6.25%. The reputed company full salary range for this role is $64,000.00 to $106,000.00. #LI-remote About Cambia Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, To view the full job description, click here Remote Skills: Adjudication, Analysis Skills, Artificial Intelligence (AI), Best Practices, Claims Management, Claims Processing, Communication Skills, reputed company Procedural Terminology (CPT), Documentation, Health Economics, Healthcare, ICD-10, Inventory Management, Legal, Medical Terminology, Policy Development, Procedure Development, Regulations, Sales Prospecting, Stop Loss Insurance, Systems Maintenance, Team Player, Time Management, Work From Home About the Company: reputed company reputed company is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system. Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:

• help people reputed company reputed company and well-being
• reputed company health care more available, affordable and accessible
• are easily understood by everyone

We put people at the heart of everything we do. Our company reaches more than 70 million Americans reputed company, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans. Company Size: 5,000 to 9,999 employees Industry: Healthcare Services Founded: 1940 Website: https://www.cambiahealth.com/careers Apply tot his job Apply To this Job