ABOUT US
Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we’re fully integrated with our long-term partners, who are recognized as industry leaders.
POSITION SUMMARY
The Specific Stop Loss Specialist (SLSS) plays a critical role in managing Specific Reimbursements and Advance Funding processes for self-funded and level-funded clients. This position requires a strong grasp of claims processing to conduct effective informational research and ensure accurate coordination and filing.
DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:
- Coordinate and file Specific Reimbursements and Advance Funding requests.
- Conduct detailed research using claims data to support reimbursement processes and payments.
- Documentation of authorizations and/or denials by the stop loss carriers
- Maintain professional communication with internal teams, vendors, and clients
- Operate independently while meeting deadlines and compliance standards
- Manage and track the received, pended, and completed claim files
- Document escalations and/or authorizations for release of claim payments
- Monitor claims email box for large dollar claims that will affect Stop Loss
- Assist with other administrative tasks as needed
Other job duties include, but are not limited to the following:
- May perform other duties as assigned.
MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)
- Intermediate level computer skills, including Microsoft Word, Excel, and Outlook
- A high school diploma or GED certificate
- At least 3 years' experience as a claim examiner processing first-dollar medical claims
- Stop loss insurance knowledge a plus
- Overall knowledge of the Healthcare industry
- Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
- Strong communication and organizational skills
- Excellent written and verbal communication skills.
OTHER DETAILS
Supervisory Responsibilities
None.
Work Environment
The noise level in the work environment is usually low to moderate.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.
Travel Requirements
None.
NOTE
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.
The Company complies with employment regulations as they apply to the location of service.