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Stop Loss Medical Claims Representative

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Job Details
Job Order Number
Company Name
Medova Healthcare
Physical Address
Wichita, KS 67203
Job Description

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 group’s 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

Analytical Skills
Technical Capacity
Problem Solving
Attention to Detail

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)

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