Aggregate Stop Loss Claims Auditor

Summary

Brown & Brown is an insurance company seeking an Aggregate Stop Loss Claims Auditor to support its growing team. The role analyzes and audits aggregate stop loss claims, validates contract eligibility and funding, performs enrollment and attachment point calculations, prepares audit deliverables, responds to appeals, and contributes to process improvements.

Responsibilities

• Analyze Aggregate Stop Loss Year End claims, High Level Review and Aggregate Accommodation claims
• Validate which expenses are eligible under the aggregate stop loss contract, identify and validate eligibility exceptions, extra-contractual claims and verify funding
• Perform enrollment evaluation and calculations to ensure the correct calculated or minimum attachment point is applied
• Produce deliverables related to audit findings, including Audit Report for client, Exhibits and Non Exhibits, within the Company accepted timeframes; and respond to all appeals from TPAs
• Contribute innovative ideas and assist with the implementation of new processes

Skills

• Must have Excel Proficiency to include knowledge of Basic or Advanced Formulae and PIVOT Tables
• Minimum 3-4 years of experience with self-funding plus specific and/or aggregate claims; or reinsurance claims
• Demonstrated proficiency in Microsoft Office, to include Microsoft Word and Outlook
• Demonstrated strong analytical/critical thinking skills
• Demonstrated organizational skills, time management skills and detail‐oriented focus
• Strong written and verbal communication skills
• Ability to work independently with minimal supervision
• Prior experience with self-funding and the stop loss product
• Prior experience reviewing and/or auditing aggregate stop loss claims
• History of successful Process Improvement initiatives
• Occasional travel may be needed

Qualifications

Must Haves

• Must have Excel Proficiency to include knowledge of Basic or Advanced Formulae and PIVOT Tables
• Minimum 3-4 years of experience with self-funding plus specific and/or aggregate claims; or reinsurance claims
• Demonstrated proficiency in Microsoft Office, to include Microsoft Word and Outlook
• Demonstrated strong analytical/critical thinking skills
• Demonstrated organizational skills, time management skills and detail‐oriented focus
• Strong written and verbal communication skills
• Ability to work independently with minimal supervision

Nice to Haves

• Prior experience with self-funding and the stop loss product
• Prior experience reviewing and/or auditing aggregate stop loss claims
• History of successful Process Improvement initiatives
• Occasional travel may be needed

Benefits

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
• Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.