Senior Claim Benefit Specialist - Stop Loss (Hybrid)

Are you a highly skilled and experienced professional in the insurance industry? Are you passionate about utilizing your knowledge and expertise to make a positive impact on people's lives? If so, we have an exciting opportunity for you to join our team as a Senior Claim Benefit Specialist - Stop Loss (Hybrid) at Aetna.In this role, you will be responsible for reviewing and adjudicating complex stop loss claims, utilizing your in-depth understanding of stop loss principles and procedures. You will also be a key point of contact for our clients, providing exceptional customer service and building strong relationships.To be successful in this position, you must possess a bachelor's degree and have at least 5 years of experience in the insurance industry, with a focus on stop loss claims. You should also have strong analytical and problem-solving skills, excellent communication and interpersonal abilities, and a commitment to delivering high-quality work.If you are looking for a challenging and rewarding career opportunity with a leading healthcare company, we encourage you to apply for this position. Join us in our mission to improve the health and well-being of our members and communities.

1. Review and adjudicate complex stop loss claims in a timely and accurate manner.
2. Utilize in-depth knowledge of stop loss principles and procedures to ensure claims are processed correctly.
3. Serve as a key point of contact for clients, providing exceptional customer service and building strong relationships.
4. Communicate with clients and internal teams to gather necessary information and resolve any issues or concerns.
5. Monitor claim trends and identify opportunities for improvement in processes and procedures.
6. Collaborate with other team members to ensure timely and accurate processing of claims.
7. Stay up-to-date on industry trends and regulations related to stop loss claims.
8. Train and mentor junior team members to ensure their understanding and proficiency in stop loss claims.
9. Handle escalated or complex claims and provide guidance and support to team members.
10. Maintain accurate and detailed records of claims and related communication.
11. Communicate complex information and decisions to clients and internal stakeholders.
12. Participate in meetings and presentations to showcase the team's performance and share insights.
13. Conduct quality assurance checks to ensure accuracy and compliance with company standards.
14. Assist in developing and implementing new processes and procedures to improve efficiency and effectiveness.
15. Collaborate with other departments and teams to ensure seamless claims processing and exceptional customer service.

According to JobzMall, the average salary range for a Senior Claim Benefit Specialist - Stop Loss (Hybrid) is $60,000 to $80,000 per year. However, this can vary depending on factors such as location, experience, and company size. Some companies may offer higher salaries for this position, particularly those in high-demand industries or locations. Additionally, individuals with specialized skills or certifications may also earn higher salaries.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.