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

Resident Assistant

If you’re looking for a job that goes beyond the basics to deliver purpose and j...

Location

United States of America , Hillsboro

Salary:

18.00 - 20.00 USD / Hour

Leisure Care

Expiration Date

Until further notice

Requirements

Demonstrated experience in a caregiving role
Current CNA a plus!

Job Responsibility

Assists resident with activities of daily living (ADL's) and all personal care skills (bathing, dressing, grooming, toileting)
Makes appropriate observations about the resident’s condition in every interaction
Records and follows-up with changes in resident’s condition in a timely manner
Assists residents with laundry and housekeeping services as needed

What we offer

Medical, Dental and Vision
Early Wage Access (access to earned wages when needed!)
401k
10 days vacation & 1 hour Sick Leave earned for every 30 hours worked
Bereavement & Jury Duty Leave
6 Holidays
2 Float Holidays
Flexible Spending Accounts (Health and Dependent Care)
Meal Discounts
Tuition Assistance

Fulltime

Traffic Management CAD Technician

FM Conway is currently recruiting a Traffic Management CAD Technician to join ou...

Location

United Kingdom , Ipswich

Salary:

Not provided

360 Resourcing Solutions

Expiration Date

July 04, 2026

Requirements

Strong knowledge of Traffic Management operations
experience using CAD, BricsCAD and Cone 11 software
ability to read and translate blueprints and technical drawings
ability to work well under pressure, prioritise tasks effectively and have excellent attention to detail
M7 Lantra qualification is highly desirable, but not essential

Job Responsibility

Working within a team of Traffic Management development designers and Project Engineers to ensure that drawings are to a high and legal standard
Producing clear drawings, signage placement layouts and diversion route strategies
Developing safe and efficient traffic management plans for work sites and road network
Carrying out on site assessments as required
Designing sites in accordance with Chapter 8 TSM
Engaging with Project Teams & Engineers to respond effectively to working methods that require traffic Management designs that conform to a legal standard

What we offer

Career and professional development
23 days holiday plus bank holidays
Life assurance
Opportunities for internal and external training
Access to a wide range of shopping discounts through Rewarding Great People platform
Health and well-being benefits including 24-hour advice lines
Support from in-house mental health first aiders

Fulltime

Registered Nurse, CVOR

Baptist Downtown is hiring a Registered Nurse for our Cardiovascular Operating R...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

1-2 years Operating Room Nursing Experience Required
Basic Life Support (BLS) Required
Advanced Cardiac Life Support (ACLS) Required
Licensed Registered Nurse Required
Associate of Science, Nursing
Registered Nurse (RN) - State Nursing Boards
Driver's License - DMV
Basic Life Support (BLS) - AHA
Advanced Cardiac Life Support (ACLS) - AHA

Job Responsibility

Providing for patient needs as recognized through use of the nursing process
Supervision of care provided by supportive personnel and coordination of care provided by ancillary services
Including patients and significant others (SO)/families in developing an individualized plan of care
Education of patients/SO/families to their disease process and plan of care
Coordinating and preparing assigned operating room/case
Assessment of patient care needs and the anticipation of needs of the case
Circulating, scrubbing, assisting on Cardiothoracic and vascular procedures

Fulltime

Pediatric Occupational Therapist

Wolfson Children's Hospital Rehab Services is hiring a Pediatric Occupational Th...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Bachelor's degree (or higher) in Occupational Therapy Required
Licensed Occupational Therapist from FL Department of Health Required
Basic Life Support (BLS) certification from the American Heart Association Required
Pediatric Occupational Therapy in the outpatient setting is strongly preferred

Job Responsibility

Evaluates and treats patients with developmental, neurological, orthopedic, and medical diagnoses
Extensive patient/family education
Works with multidisciplinary team care

What we offer

$1,000 Sign on Bonus

Nursery Manager

Join the Kindred Family – Lead, Inspire, and Make a Difference. Are you an exper...

Location

United Kingdom , Hauxton

Salary:

34000.00 - 36000.00 GBP / Year

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Proven experience in leading and managing a team within early years
Strong written and verbal communication skills
Excellent organisational skills and attention to detail
Outstanding customer service and time management
Full and relevant Early Years Level 3 Childcare Qualification or higher
Sound knowledge of EYFS and OFSTED guidelines

Job Responsibility

Lead the Deputy Manager, Third in Charge, and Room Leaders to ensure high standards of Early Years care and education
Maintain an organised, safe, and stimulating nursery environment
Keep accurate records and ensure procedures are followed across the nursery
Build and maintain a reputation as the nursery of choice for children and staff
Model and monitor best practice in line with regulatory guidelines
Inspire and support your team, overseeing inductions, mentoring, and ongoing development
Ensure the nursery runs efficiently, meets KPIs, budgets, and targets, and is prepared for audits and inspections
Oversee the day-to-day operations of the nursery
Lead by example, modelling good practice and creating a shared vision
Supervise, support, and allocate tasks to your team

What we offer

Birthday Off
6 Fully Paid Sick Days
Cashback Healthcare Plan
Retail Discounts
Recognition & Reward Scheme
50% Childcare Discount
24/7 Virtual GP Access
24/7 Counselling Support
Discounted Gym Membership
Personal Financial Advisor Access

Fulltime

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Stop Loss Auditor

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