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Medica · 2 weeks ago

Claim Analyst III Stop Loss

Hopkins, MN

Full-time

Onsite

Mid, Senior Level

$46K/yr - $66K/yr

5+ years exp

Medica is a nonprofit health plan serving communities in multiple states. The Claim Analyst III (Stop Loss) is responsible for reviewing, analyzing, and processing stop-loss claims, ensuring accuracy and compliance while building relationships with stakeholders and supporting process improvements.

Health CareMedical

No H1B

Responsibilities

Review and Analyze Claims: Examine stop-loss claims to confirm eligibility, contract terms, and policy limits. Ensure claims are processed accurately and meet production standards

Claims Verification: Verify that all underlying claims are paid appropriately according to standard operating procedures

Claims Tracking and Reconciliation: Track claim submissions, monitor status, and reconcile medical records and correspondence. Collaborate with internal teams (Claims, Utilization Management, Client Services) to resolve eligibility and coordination-of-benefits issues

Process Improvement: Identify opportunities to enhance accuracy and turnaround time (TAT) for stop-loss claims. Support management with ad hoc analysis and reporting related to claims adjudication and stop-loss

Stakeholder Engagement: Build and strengthen relationships with stakeholders through effective problem resolution and communication

Qualification

Claims AnalysisICD-10 CodingCPT/HCPCS CodingClaims Systems ProficiencyMicrosoft ApplicationsAnalytical SkillsOrganizational SkillsCommunication SkillsAttention to Detail