Established Senior Stop Loss Claims Examiner

Silver Spring, Maryland
Apr 03, 2017
May 08, 2017

Job Summary/Company:
Are you looking for a company that provides great work life balance and benefits? This is an opportunity to join a reputable financial services Market Leader who is currently seeking an established Sr. Claims Examiner.  


  • Audit and process large reinsurance Stop Loss claims submitted by Third Party and/or Self-Funded Claims Administrator in accordance with the Summary Plan Document and
  • Stop Loss Policy provisions; claims using automated claims system.
  • Handle complex telephone and written inquiries from policyholders, claimants, claims administrators and other internal and external customers.
  • Bring claims to satisfactory conclusion to include verifying eligibility using various source documents, initiating written and/or telephone inquiries to clients, and to the final stage of releasing claims' benefit payments.
  • Research and communicate information relative to claims eligibility, appeals and denials.
  • Maintain good relationships with clients.
  • Assist other staff members in processing of claims as needed.
  • Perform other job related duties as may occasionally be assigned.

Qualifications/Background profile:

  • Two years of administrative experience, preferably in an insurance environment.
  • Working knowledge of insurance terminology, medical terminology, ICD-9, CPT-4 and HCSPC coding
  • Must successfully demonstrate ability to meet or exceed productivity and error ratio standards.
  • Demonstrated oral and written communication skills

Qualified candidates should send their resume OR call Sparks Group for additional details. Please note resume must include a valid email address in order to be considered.

We look forward to discussing your background, your current job search, and your potential career path with Sparks Group!

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