Stop Loss Examiner

SymetraBellevue, WA, United States

job_description.job_card.variable_hours_ago

serp_jobs.job_preview.job_type

serp_jobs.job_card.full_time

job_description.job_card.job_description

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

About the role

The Claims Examiner is considered an entry level claims position within the stop loss department. Their expertise is considered foundational in the review, research, and resolution of specific stop loss claim situations. Duties include : the review and processing of claims; to include identifying and referring cases for cost-containment intervention and subrogation investigation, basic understanding of plan document review and policy provisions such as "experimental / investigational," "medically necessary", etc. This position has a fundamental understanding of the stop-loss claims adjudication process. Dollar authority from $0 - $75,000.

What you'll do in this role

Manage block of business, aligned with assigned RGM.
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 stated turnaround time goals.
Provide ad-hoc and year-end review of Policyholder reimbursements.
Maintain>

99% quality on claim procedures and financial accuracy which includes rudimentary documentation of pertinent claimants, plan, and policy information.

Support or back-up of peers, as needed. Production standards are within 4% - 6% of claim volume.

Maintain current pending claim files with consistent follow-up, documentation, and resolution or closure within defined timeframes. Interacts with administrator contacts and other internal / external resources to clearly communicate information needed to make reimbursement decision.

Provide prompt turnaround when requested information is received for reimbursement or denial.

Refine and increase knowledge of stop loss partners (other supporting departments), cost containment, best business practices, and providing and obtaining education in industry claim treads and cost containment solutions.

Claims examiners may be more reactive and transactional with internal and external communications or requests.

Special projects as identified by management.

What we offer you

"Just do it! Even if you feel like you may not be 100% qualified, apply. Sometimes we see potential in others that they cannot see in themselves. You may be overqualified, or you may be the "something special" we are looking for to bring a unique, fresh approach to our company." - Ruby S., Associate EDX Analyst

If you want to work for a company that is always considering its employees while working towards sustainable growth this is that company. Within Symetra, there is always innovation, empowerment, and growth opportunities, all while providing us with a great work / life balance and incredible benefits for a very reasonable cost!" - Cindy J. G., Sr. Product Owner

"Symetra is truly a great place to work. The positive work climate, strong sense of team, and the resources available make it feel like one cohesive family. What stands out most to me is the company's deep commitment to diversity, equity, and inclusion-it's not just a statement, it's an active and ongoing priority that's felt throughout the organization." -Charlotte G., Sr. Underwriter - Consultant Stop Loss

Benefits and Perks

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 opens a pdf file

Compensation

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

Please review Symetra's Remote Network Minimum Requirements :

As a remote-first organization committed to providing a positive experience for both employees and customers, Symetra has the following standards for employees' internet connection :

Minimum Internet Speed : 100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband."

Internet Type : Fiber, Cable (e.g., Comcast, Spectrum), or DSL.

Not Permissible : Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up.

When applying to jobs at Symetra you'll be asked to test your internet speed and confirm that your internet connection meets or exceeds Symetra's standard as outlined above.

Who you are

Strong analytical and contract interpretation skills.

Strong communication skills (oral and written).

Objective decision-making skill.

Ability to work with deadlines. Function effectively in a changing environment. Proficient in PC use.

High School diploma or equivalent experience required

We empowerinclusion.

At Symetra,we aspire to be the most inclusive insurance company in the countrywe're building a place where every employee feels valued, respected, and has opportunities to contribute. Inclusion is about recognizing our assumptions, considering multiple perspectives, 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 financialfreedom.

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.

#LI-OR1

#LI-Remote

serp_jobs.job_alerts.create_a_job

Examiner • Bellevue, WA, United States