Stop Loss Auditor Job at Daley and Associates

Senior Stop Loss Auditor

A Connecticut based Medical Insurance company is seeking an experienced Senior S...

Location

United States

Salary:

75000.00 - 90000.00 USD / Year

Daley and Associates

Expiration Date

Until further notice

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

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

Fulltime

Clinical Specialist, Quality Management I

Who We Are: Because health is personal. That's why Personify Health created the ...

Location

United States

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

Active, unrestricted Registered Nurse (RN) license required
Basic computer literacy
The ability to work on multiple screens, and proficient typing skills
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Ability to work independently and utilize written resources to problem solve
After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in: Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Excellent verbal and written communication skills for upward and downward conversations
Level I: In-depth knowledge of applicable regulations and accreditation standards (HIPAA, CMS requirements as applicable, NCQA, URAC)

Job Responsibility

Ensure compliance with state, federal, and accreditation requirements (e.g., HIPAA, CMS, NCQA, URAC, ERISA, as applicable)
Conduct internal and external audits of UM/CM/CDM processes and documentation
prepare audit files, findings, and corrective action recommendations
Identify quality and compliance risks and collaborate with cross-functional partners on mitigation and resolution
Review and support SOPs and workflows to ensure regulatory alignment and operational clarity
Support external audit readiness activities, including NCQA and URAC evidence preparation and maintenance
Develop, maintain, and deliver role-based training curriculum aligned to compliance standards, quality goals, and operational workflows
Conduct onboarding and orientation to prepare staff for assigned UM/CM/CDM functions
Deliver training using multiple modalities (virtual, self-paced, and one-on-one coaching) tailored to adult learners
Ensure training covers applicable processes such as case initiation and closure, documentation standards, high-dollar case monitoring, stop-loss notification, administrative support, customer service, and productivity expectations

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Unlimited PTO—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Associate Medical Risk Consultant

Berkshire Hathaway Specialty Insurance is seeking Associate Medical Risk Consult...

Location

United States , Indianapolis

Salary:

65000.00 - 85000.00 USD / Year

Berkshire Hathaway Specialty Insurance

Expiration Date

Until further notice

Requirements

1+ years of medical stop loss support experience, preferred
Knowledge of medical billing codes (ie: ICD10, CPT, HCPCS, REV, NDC)
Experience in Medical service industry (ie: medical office staff, acute care setting, home health care, insurance, stop loss)
Ability to work in high volume, rapid response environment
Ability to multi-task and shift priorities as needed
Exceptional attention to detail and strong organizational skills are imperative
Excellent verbal and written communication skills
Demonstrated excellence with Microsoft Excel
Experience with Excel
PDFs

Job Responsibility

Assist in managing the Employer Stop Loss referral mailbox
Assist with new and renewal group set up in Medical Underwriting ESL Office (Stop Loss Software) including uploading documents and entering data for identified risks
Manage Renewal Assignment report for the Medical Risk Consultant Team
weekly update of Renewal Assignment report with group sale notifications/data
Run various reports for nurses, auditors, and management as requested
Perform data review to identify pertinent data for medical risk reviews (ie: various Excel functions including pivot tables and charts
formulas
data cleaning, data sorting
report preparation for reviews)
Upload pertinent documents into AMS Profiler

What we offer

Comprehensive Health, Dental and Vision benefits
Disability Insurance (both short-term and long-term)
Life Insurance (for you and your family)
Accidental Death & Dismemberment Insurance (for you and your family)
Flexible Spending Accounts
Health Reimbursement Account
Employee Assistance Program
Retirement Savings 401(k) Plan with Company Match
Generous holiday and Paid Time Off
Tuition Reimbursement

Fulltime

Content Project Manager

Location

United Kingdom , City of London

Salary:

100.00 - 120.00 GBP / Day

Randstad

Expiration Date

July 04, 2026

Requirements

2-4 years of experience within project coordination, digital marketing administration, or content operations
A confident communicator who is comfortable handling client requests and chasing third-party suppliers for assets
Direct experience utilising standard project tracking tools (e.g., Asana, Trello, or Basecamp) and a foundational understanding of the social media landscape
An execution-focused professional who takes absolute ownership of deadlines and thrives in a fast-paced environment

Job Responsibility

Partnering directly with corporate brands to map out project specifications and drafting comprehensive execution briefs
Briefing external creative partners and monitoring their deliverables to guarantee all assets meet platform-specific technical standards
Tracking the end-to-end production lifecycle to ensure every milestone is hit on-spec, on-time, and within budget parameters
Serving as the key point of contact to maintain seamless alignment between internal teams, external vendors, and the clients themselves
Managing complex delivery schedules and proactively identifying potential delivery risks before they cause campaign delays

Fulltime

Behavioural Support Assistant

Behavioural Support Assistant | SEMH & Mentorship | Local Secondary Schools. Pos...

Location

United Kingdom , Brixton

Salary:

89.00 - 95.00 GBP / Day

Randstad

Expiration Date

July 07, 2026

Requirements

Naturally Resilient
Relevant Experience (PRU, youth work, sports coaching, residential care, psychology, police/military)
Strong Communicator
Committed (enhanced DBS, dedicated to Safeguarding and child welfare)

Job Responsibility

De-escalation & Support
1:1 & Small Group Mentorship
Inclusion Support
Collaborative Strategy

What we offer

Weekly Pay
Referral Bonus
Training and Education
Safeguarding & Prevent

Behavioural Support Assistant

Behavioural Support Assistant | SEMH & Mentorship | Local Secondary Schools. Pos...

Location

United Kingdom , Uxbridge

Salary:

89.00 - 95.00 GBP / Day

Randstad

Expiration Date

July 07, 2026

Requirements

Resilient
Patient
Relevant experience in PRU, youth work, sports coaching, residential care, psychology, police/military
Strong communication skills
Committed
Hold an enhanced DBS (or willing to apply)
Dedicated to Safeguarding and child welfare

Job Responsibility

De-escalation & Support
1:1 & Small Group Mentorship
Inclusion Support
Collaborative Strategy

What we offer

PAYE
Referral Bonus
Weekly Pay
Training and education
Safeguarding & Prevent

Fulltime

Specialist Mentor - Sm Asc

Specialist Mentor SM-ASC | Autism Support | Location: York Rate of Pay: £28 per ...

Location

United Kingdom , York

Salary:

28.00 GBP / Hour

Randstad

Expiration Date

August 29, 2026

Requirements

Strong communication and interpersonal skills
Proficiency in utilising educational technologies
Passion for student success
Completion of relevant National Autistic Society (NAS) training modules (support provided)
Teaching experience
University education

Job Responsibility

Provide individualised academic support to students
Develop and implement personalised learning plans
Guide students towards academic success
Collaborate with teachers and support staff
Utilise educational technologies effectively
Maintain accurate student records

What we offer

Competitive hourly rate (£28 + £3.38 accrued holiday pay)
Part-time, flexible hours
Supportive work environment
Opportunity to make a significant impact
Chance for professional growth
Certificate from the National Autistic Society

Parttime

Welder/Fabricator

Build the machines that move the earth. We are seeking skilled, flexible Welders...

Location

United Kingdom , Stockton-on-Tees

Salary:

24.10 GBP / Hour

Randstad

Expiration Date

June 30, 2026

Requirements

Previous experience of Fabrication
Time Served Welder
Relevant NVQ Level 3

Job Responsibility

Work on build/weld fixtures to tight tolerances
Work under own initiative as well as part of a team
Follow a standard work procedure/housekeeping
Carry out some manual lifting
Use overhead cranes
Jig work
Adhering to PPE requirements and standards in place

What we offer

Overtime available
On site occupational health
Additional holidays per year added to allowance depending on service
Worker recognition schemes
Full induction and ongoing training
Potential to be made permanent with our client
Development opportunities and ability to apply for internal CAT roles
Auto enrolment pension scheme
Access to Randstad Benefits app
Dedicated On site Randstad team to help with any queries

Fulltime

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Stop Loss Auditor

Job Description

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