Stop Loss Claims Analyst

Join to apply for the Stop Loss Claims Analyst role at Cambia Health Solutions
.

Work from home within Oregon, Washington, Idaho or Utah.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Every day, Cambia’s dedicated team of Stop Loss Claims Analysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop-loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations – all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

• High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.

• Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
• Strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all 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.

• Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims.
• Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
• Lead the process to measure, track, and report all aggregate claims.
• Audit all aggregate claims onsite and off-site when 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 efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes.
• Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner.

• 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 target for this position is 10%. The current full salary range for this role is $64,000.00 to $.

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5

Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email C Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.