Health In Tech (HIT) is an innovative insurance technology platform company that offers technical solutions to transform and improve efficiency in the healthcare industry with vertical integration, process simplification, and automation that removes friction and complexities. We make self-funding accessible for small businesses and deliver cost and time savings for employers, members, brokers, Third Party Administrators (TPAs), and providers. HIT was founded on the belief that self-funded benefits should be simple and streamlined with 100% transparency. With over 30 years of industry experience in our management team, we understand the complexities of healthcare, and we know how to integrate the multifaceted aspects of the industry. Our solutions and technology platforms like Stone Mountain Risk, eDIYBS, HI Card, and HI Performance Network do exactly this through vertical integration, process simplification, automation, and digitalization. We empower you with industry-leading tools and technology to streamline the entire self-funding process with solutions that prioritize interoperability, efficiency, and user empowerment.

Job description

Health in Tech (HIT) is reimagining and simplifying the way self-funded health plans are designed, priced and packaged for small to mid-sized companies. We are a fast-growing company combining the expertise of software developers, reinsurance specialists, insurance administrators and health-care providers to challenge the high-cost of health insurance for businesses and dramatically simplify the buying process.

Summary

The Stop Loss Claims Specialist is responsible for the reconciliation of information/documentation from third-party administrators, and the adjudication and reconciliation of Aggregate Stop Loss Claims.

Duties And Responsibilities Include

Review Aggregate Claim Reports and other related documentation to determine if refunds are due to the Policyholders, along with assist in the pursuit of subrogated matters and assorted types of overpaid claim scenarios, as applicable.
Review and adjudicate Monthly Aggregate Accommodation Requests, taking into consideration all applicable Stop Loss Policy Provisions, Plan Document Provisions, and internal claims processing protocols, within assigned authority limit.
Perform Claim Intake Process, as needed
Regularly follow up with Third Party Administrators ("TPAs") and Policyholders to check status of our requests for information/documentation in pended claim scenarios.

Qualifications For The Stop Loss Claims Specialist Include

4+ years of experience with medical claims processing and adjudication.
Experience with third party administration, self-funding, stop loss claims, excess loss claims, and/or reinsurance is preferred. Aggregate claim experience is also preferred.
Knowledge of CPT, ICD-10, and HCPCS codes, along with knowledge of medical claim practices.
Strong analytical skills/abilities, along with having keen critical decision-making and problem-solving skills, are a must.
Highly proficient in Microsoft Office applications, especially Outlook, Excel, and Word.
Excellent verbal and written communication skills, along with sound organizational skills, and effective customer service abilities

Salary: $70000 per year

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