This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
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.
Job Responsibility:
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
Requirements:
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