[Hiring] Specific Stop Loss Claims Auditor @Brown & Brown Insurance

Role Description

Brown & Brown is seeking a Specific Stop Loss Claims Auditor to join our growing team. The incumbent is responsible for providing Specific Stop Loss claims auditing services for MGU and/or Carrier clients.

• Analyze Specific Stop Loss claims.
• Identify and isolate the data that is specific to a particular claim submission.
• Validate which expenses are eligible under the stop loss policy and summary plan description.
• Accurately apply all deductibles, coinsurances, aggregating specific deductibles and lasers.
• Provide customer service for MGU partners and their respective TPAs.
• Conduct timely follow up on all pended claims.
• Contribute innovative ideas and assist with the implementation of new processes.

Qualifications

• Must have Excel Proficiency to include knowledge of basic formulae, sorting techniques and PIVOT Tables.
• Minimum 2 years Claims experience with first dollar medical claims, specific and/or aggregate claims, HMO reinsurance and/or provider excess claims.
• Prior experience with industry repricing methodologies (PPO, Wrap Networks, Reference Based Pricing, etc.).
• Demonstrated proficiency in Microsoft Office, including Microsoft Outlook.
• Demonstrated strong analytical/critical thinking skills; and detail-oriented focus.
• Strong written and verbal communication skills.
• Ability to work independently with minimal supervision.

Requirements

• Preferred prior experience auditing managed care or specific/aggregate stop loss claims.
• History of successful Process Improvement initiatives.

Benefits

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance.
• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement.
• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services.
• Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.