Specific Stop Loss Claims Auditor (Healthcare Insurance)

Location: Remote - USA

Salary: $75,000–$90,000 annually

Company

Brown & Brown provides insurance and risk management services, including healthcare claims audit services through its Corporate Benefit Audits division.

What you will do

• Analyze specific stop loss claims for MGU and carrier clients.
• Identify and isolate data related to individual claim submissions.
• Validate eligible expenses under stop loss policies and summary plan descriptions.
• Apply deductibles, coinsurance, aggregating specific deductibles, and lasers accurately.
• Provide customer service to MGU partners and their third-party administrators.
• Follow up on pended claims and support process improvements.

Requirements

• At least 2 years of experience with first-dollar medical claims, specific or aggregate claims, HMO reinsurance, or provider excess claims.
• Experience with industry repricing methodologies, including PPO, wrap networks, and reference-based pricing.
• Proficiency in Microsoft Excel, including basic formulas, sorting, and PivotTables.
• Proficiency with Microsoft Office, including Outlook.
• Strong analytical, critical-thinking, written, and verbal communication skills.
• Ability to work independently with minimal supervision and maintain close attention to detail.

Nice to have

• Experience auditing managed care or specific/aggregate stop loss claims.
• Successful process improvement experience.

Culture & Benefits

• Meritocratic culture focused on initiative and customer outcomes.
• Medical, prescription, dental, vision, life, and disability insurance.
• Employee stock purchase plan, 401(k), student loan assistance, and tuition reimbursement.
• Mental health and enhanced advocacy services.
• Paid time off, holidays, and preferred partner discounts.