Remote – Senior Stop Loss Auditor
A Connecticut based Medical Insurance company is seeking an experienced Senior Stop Loss Auditor to join a fully remote team supporting medical stop loss insurance operations. This role focuses on auditing high-cost medical claims, evaluating liability under stop loss policies, and ensuring accurate and compliant reimbursement.
Compensation: $75,000 – 90,000 base
Responsibilities
- Lead audits of complex and high-cost medical stop loss claims for assigned clients
- Interpret and apply Plan Documents and Stop Loss policy provisions
- Evaluate reimbursement submissions and render claim determinations
- Verify eligibility, financial accuracy, and medical coding compliance
- Review claims for coordination with cost containment programs
- Ensure claims are processed within established accuracy and turnaround standards
- Identify and pursue recovery of overpaid claims
- Maintain detailed audit documentation and reporting
- Partner with TPAs, carriers, and internal teams throughout the approval process
- Support cross-functional collaboration and knowledge sharing across teams
Qualifications
- 3+ years of medical stop loss insurance experience at the Senior level (required)
- Experience auditing stop loss or first-dollar medical claims
- Strong knowledge of: Plan Documents and Stop Loss policies, Reinsurance contracts, Medical terminology and coding (ICD-10, HCPCS, CPT-4)
- Ability to work independently in a remote environment while collaborating with a team
This is a fully remote opportunity! For immediate consideration, please reach out directly to Kelly Lucey at [email protected] with a copy of your resume.
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