This Medical Claims Processor Position Features:
• Growth Opportunities
• Centrally Located
• Awesome Culture
• Great Pay

Are you looking for an amazing medical company to work for? Do you have a few years within TPA or Group Medical Benefits? If so, then this is the Direct Hire opportunity for you!

The Medical Stop Loss Claims Specialist shall be responsible for all processes related to seeking reimbursements for Stop Loss or Aggregate claims. Including but not limited to identifying claimants, requesting reimbursement, and providing all required documentation to Stop Loss carrier. Including handling all follow-up documentation or communication necessary to receive reimbursements.

Qualifications:
• 4+ years of experience with medical claims processing and adjudication.
• Experience with third party administration, self-funding, stop loss claims, excess loss claims, and/or reinsurance is preferred. Aggregate claim experience is also preferred.
• Medical Claims Processing and Adjudication: 4+ years
• Stop Loss Claims: 1 year (Required)
• Must have knowledge of CPT, ICD-10, and HCPCS codes, along with knowledge of medical claim practices. Additional knowledge of medical billing and coding practices preferred.
• Strong analytical skills/abilities, along with having keen critical decision-making and problem-solving skills, are a must.
• Highly proficient in Microsoft Office applications, especially Outlook, Excel, and Word.
• Excellent verbal and written communication skills, along with sound organizational skills, and effective customer service abilities are necessary.

Schedule: Monday-Friday 8:00am-5:00pm
Pay: $22.00/h-$25.00/hr DOE
Location: Greenville, SC 29601

If this sounds like something you would be interested in, apply for this great position as a Stop Loss Claims Specialist / Medical Claims Processor today!

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.