Stop Loss Claims Analyst - Carrier - REMOTE

Join to apply for the Health Insurance Claims Analyst - Carrier - REMOTE role at WAHVE LLC

1 day ago Be among the first 25 applicants

Join to apply for the Health Insurance Claims Analyst - Carrier - REMOTE role at WAHVE LLC

This range is provided by WAHVE LLC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$28.00/hr - $30.00/hr

Put your Insurance Experience to work – FROM HOME!

At WAHVE, we value significant insurance experience and want to revolutionize the way people think about phasing into retirement by offering qualified candidates the opportunity to continue their career working from home. As we say – retire from the office but not from work. Our unique platform provides you with real work/life balance and allows you to customize your own work schedule while continuing to utilize your insurance expertise in a remote, long-term position which includes company benefits!

WHAT YOU’LL LOVE ABOUT WAHVE

We created a welcoming place to work with friendly and professional leadership. We are known for the great care we take with our staff and our clients. We are passionate and determined about delivering the best customer service, preserving insurance industry knowledge, and making a difference by the work that we do.

WHAT WE ARE SEEKING

We have assignments available to help our insurance carrier or Third-Party Administrator (TPA) clients in Health Insurance Claims Analyst positions. Responsibilities include:

• Conduct a comprehensive quality review and evaluation of all claims submissions to determine if requested amount qualifies for reimbursement under the applicable Stop Loss Policy
• Independently assess the eligibility of assigned claims in a prompt manner by interpreting relevant contract terms in relation to the medical details and specific elements of each case.
• Promptly analyze the eligibility of designated claims by applying appropriate policy guidelines to the medical context and detailed claim information.
• Evaluate and resolve complex, problematic, or unique claims cases autonomously, making settlement decisions or initiating necessary follow-up actions within authorized decision-making limits.
• Demonstrate strong organizational abilities, effective verbal communication, and interpersonal skills when interacting with both internal teams and external stakeholders.

TO BECOME A WORK-AT-HOME VINTAGE EXPERT, WE REQUIRE

• 25 years of full-time work experience
• 10 most current years of health insurance claims analyst experience with insurance carrier or TPA with specific:
• 
  Medical Billing & Coding,
• 
  Medical Claims Processing and
  
• 
  Stop Loss knowledge
  

BENEFITS OF BECOMING A WAHVE VINTAGE EXPERT

• Health insurance based on eligibility.
• 401(k) with a 4% match.
• Retire from the office but not from work.
• Eliminate the office stress and the commute.
• Choose the work you would like to do now.
• Customize your schedule – full or part time.
• Utilize your years of insurance industry knowledge.
• Be part of our dynamic yet virtual team environment and connect with other experienced insurance professionals like yourself!

HOW TO GET STARTED

Click APPLY NOW to complete our simple preliminary profile. Be sure to include your preferred contact information as one of our Qualification Specialists will connect with you promptly.

WE LOOK FORWARD TO MEETING YOU!

• Seniority level Associate

• Employment type
  
  Full-time

• Job function
  
  Analyst, General Business, and Quality Assurance
• Industries Insurance and Insurance Carriers

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