S&S Health

Insurance

• Review stop loss policies and ensure accurate setup within claims management systems
• Verify policy terms and conditions, including TLO (Specific Stop Loss) and Aggregating Specific Deductible
• Collect and verify documentation for stop loss claims, including eligibility documentation, medical records, subrogation details, and cost containment reports
• Assist with timely and accurate filing of routine, specific, aggregate, and complex stop loss claims
• Collaborate with Operations, Finance, and Sales on claim status and claims-process communication
• Monitor accounts for reporting compliance
• Track premium remittances and ensure timely, accurate system data uploads
• Evaluate claim refunds and apply dollars properly to respective claim filings
• Communicate claim decisions clearly to internal teams and external clients based on policy guidelines and group plan documentation

Explore Reinsurance Claim Analyst at S&S Health. Review requirements and application details.