Stop Loss Medical Claims Representative

Job Order # Company Job Type Salary Location Application Deadline
10665384 Medova Full-Time DOE Wichita 05/21/2018
A Stop Loss Claims Representative is responsible for researching, collecting, summarizing, and submitting health insurance claims to stop loss carriers for company reimbursement. This position is part of a growing team located in downtown Wichita, KS. Essential Functions: Provide notification of potential high dollar claimants to the stop loss carrier Compile documentation and submit claims to the stop loss carrier Respond to inquiries by the carrier Process payments from the carrier and ensure that appropriate providers are then paid Work with members to obtain missing information Research and resolve any claims that were pended or denied by the carrier Track each groups runout period and active members in stop loss Compile and provide reports to stop loss carriers Work in close coordination with Claims Processors Be persistent in follow up to ensure all deadlines are met Make referrals to outside case managers Develop and maintain an excellent working knowledge of policies in order to determine eligibility benefits and process claims accurately. Assist providers and members with questions regarding their claims or policies both in writing and verbally Compile claims information for group renewal reports Draft and distribute summary plan documents Abide by HIPAA regulations and other privacy policies at all times Maintain an exemplary attendance and tardiness record following established company guidelines Demonstrate ability to work well with other departments and all Medova staff members Complete other tasks, as assigned Competencies: Analytical Skills Technical Capacity Problem Solving Attention to Detail Initiative Required Education and Experience: High School Diploma or equivalent 1 year professional office experience Preferred Education and Experience: Additional course work in business or health related field 1 year health insurance industry knowledge or medical experience Computer Skills: Microsoft Outlook Microsoft Word Microsoft Excel Ten Key (preferred) Position Type and Expected Hours of Work: Full-time Monday-Thursday 8am-5pm; Friday 8am-4pm (general) Work Environment: Professional office environment Standard office equipment such as computer, phone, postage machine, and copier/scanner/fax Tobacco free Job Type: Full-time Experience: professional office: 1 year (Required) medical claims: 1 year (Required) Education: High school (Required)

How to Apply:

Please submit resume to Brandi Clarke at brandi.clarke@medova.com

Helpful Information:

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