Stop Loss Examiner

Symetra has an exciting opportunity to join our team as Claims Examiner for Stop Loss!

About the role

In this role, you will audit individual stop loss claim submissions through analysis of policy provisions, employer plan documents, administrative agreements, and cost containment vendor agreements to process accurate claim reimbursements made payable to the policyholder. You will also, review potential claim notices and submissions for cost containment opportunities.

What you will do
• Audit and make reimbursement determinations of stop loss claims in accordance with the provisions of the Policyholder's Plan Document and Stop Loss Policy
• Adjudicate claim reimbursements within established turnaround goals
• Maintain quality on claim procedures and financial accuracy with appropriate documentation
• Handle pending claims with consistent follow up, documentation, and resolution or closure within defined timeframes
• Interact with third party administrators and other contacts to obtain information needed to make reimbursement decision
• Provide prompt turnaround when information is received for reimbursement or denial
• Review advance notices of potential claims to identify and refer cases expected to become excess loss claims
• Alert MRC's, RGMs, and Underwriters of potential catastrophic claims risk as well as unusual and complex claim issues
• Interact with internal and external customers; respond to inquiries, handle appeals, facilitate claim resolutions, and provide and obtain education in industry claim treads and cost containment solutions
• Special projects as identified by management

Why Work at Symetra

Here’s what some of our employees have to say about why they work at Symetra:

“Symetra is a great place if you are looking for the opportunity to contribute, to grow, to be seen and valued.” Vernell K. - Auditor

“We're big enough to make an impact on the country, but small enough to care and know who you are and what you're contributing to the organization. All new ideas are welcome!” Stephanie F. – VP Customer Service & Operations

What we offer you

We don’t take a “one-size-fits-all” approach when it comes to our employees. Our programs are designed to make your life better both at work and at home.
• Flexible full-time or hybrid telecommuting arrangements
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
• Paid time away including vacation and sick time, flex days and ten paid holidays
• Give back to your community and double your impact through our company matching
• Want more details? Check out our Symetra Benefits Overview

Compensation

Salary Range: $23.92-39.85/hr plus eligibility for annual bonus program

Your experience and skills
• High School Diploma required; college degree preferred
• 1-3 years of first dollar medical claims paying experience or medical insurance related experience is required
• Prior Stop Loss claims and catastrophic claim experience preferred
• Knowledge of the fundamental concepts of group health insurance, ERISA, employee benefit plans and reinsurance
• Proficient in medical terminology, use of ICD-10 and CPT coding, UB92 identifiers and HCFA forms
• Strong analytical and contract interpretation skills
• Experience with Microsoft Office Suite and intermediate Excel skills required
• ESL – Stop Loss/Young Consulting System experience a plus
• Strong verbal and written communication skills
• Adept analytical, technical, and problem-solving skills
• Objective decision-making skills
• Able to work within timeframes and adapt to changes in priorities
• Self-motivated and driven
• Phenomenal at relationship building

We empower inclusion

At Symetra, we aspire to be the most inclusive insurance company in the country. We’re building a place where every employee feels valued, respected, and has opportunities to contribute.

Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here.

Creating a world where more people have access to financial freedom

Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we’re guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they’re buying, and we design products—and operate our company—to stand the test of time. We’re committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom.

For more information about our careers visit: https://symetra.eightfold.ai/careers

Work Authorization

Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.

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