Specific Stop Loss Claims Auditor

The Specific Stop Loss Claims Auditor will support claims data coordination and analysis for key clients with stop loss policies managed outside pharmacy benefit managers (PBMs) and other third-party administrators. This role focuses on identifying specific stop loss claimants, preparing accurate data for claim entry, and helping ensure reliable claims operations. The successful candidate will use analytical expertise to interpret claims information, develop dashboards, and communicate meaningful insights to leadership. In addition to day-to-day data analysis, the position will contribute to continuous improvement initiatives that enhance processes and operational effectiveness. Working in a remote, collaborative environment, the role offers an opportunity to apply claims knowledge and analytical skills to support client needs and informed business decisions.

• At least 3 years of experience in claims data analysis or claims operations.

• Analytical background and knowledge of specific stop loss claims.

• Bachelor's degree in Business, Analytics, or a related field, or comparable professional experience.

• Strong analytical and data interpretation skills, with the ability to identify relevant trends and insights.

• Ability to organize and prepare claims data accurately for operational use.

• Experience developing dashboards and presenting findings to leadership.

• Strong communication and collaboration skills, including the ability to explain analytical information clearly.

• A proactive, detail-oriented approach to problem-solving and continuous process improvement.