[Remote] Senior Stop Loss Auditor (Remote)

Note: The job is a remote job and is open to candidates in USA. Daley And Associates, LLC is a growing insurance company based in Hartford Connecticut, seeking a Stop Loss Auditor to join their expanding team. This position is responsible for reviewing, auditing, and determining the validity of medical stop loss claims submitted for reimbursement, ensuring all claims are processed accurately and in compliance with plan documents and stop loss policy provisions.

Responsibilities
• Audit medical stop loss claims for assigned client accounts
• Review and interpret Plan Documents and Stop Loss Policies to confirm coverage and reimbursement eligibility
• Audit and process claim reimbursement requests on behalf of carriers and reinsurers
• Ensure claims are paid in accordance with contractual terms and policy guidelines
• Review high-dollar claims for financial accuracy, medical coding accuracy, and coordination with cost containment programs
• Verify participant and dependent eligibility and maintain detailed, well-documented claim files
• Meet or exceed established accuracy, quality, and turnaround time standards
• Identify and recover overpaid claims through refund requests
• Coordinate with TPAs throughout the approval and follow-up process
• Maintain positive, professional working relationships with internal teams and external partners
• Participate in cross-training opportunities as workload allows, with claims responsibilities taking precedence

Skills
• Minimum of 3+ years of experience in medical stop loss insurance
• Hands-on experience auditing and examining medical stop loss claims
• Strong knowledge of medical terminology and coding (ICD-10, CPT, HCPCS, CPT-4)
• Experience with stop loss and/or first-dollar medical claims
• Working knowledge of Plan Documents, Stop Loss Policies, and reinsurance contracts
• Excellent verbal and written communication skills
• Highly detail-oriented with strong organizational and time-management abilities
• Ability to work independently while collaborating effectively within a team environment
• Proficiency in Microsoft Office, including Outlook, Excel, and Word
• Intermediate experience with claims systems and data entry

Company Overview
• Daley and Associates is a boutique executive search and contract staffing firm specializing in the placement of Accounting, Finance, Information Technology, Legal, Administrative and Life Sciences professionals. It was founded in 2005, and is headquartered in Boston, Massachusetts, USA, with a workforce of 11-50 employees. Its website is http://daleyaa.com.

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