Claims Adjuster- Stop Loss

Founded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees.

Role Description

We are seeking a detail-oriented Medical Stop Loss Adjuster to join our team. In this role, you will be responsible for evaluating and processing stop loss claims to ensure accurate and timely payments. You will assess claim validity, verify coverage, and determine appropriate reimbursement. The ideal candidate will have a strong understanding of medical terminology, insurance policies, and claims processing, along with excellent analytical and communication skills. This role requires a commitment to maintaining high standards of accuracy and efficiency in a fast-paced environment.

Key Duties & Responsibilities:
Review and audit claims submissions within authority level for accuracy and completeness and determine appropriate reimbursement.
Timely process claims in an accurate manner, communicate with third-party administrators, and ensure proper cost containment.
Manage inventory of pended claims according to department metrics.
Maintain appropriate reserve records on claims.
Actively participate in team meetings and training.
Skills and Qualifications:
Knowledge of Health Care services, policies, procedures and systems.
3+ years of experience with intake of Medical, Dental, Vision claims
Certified in Medical Terminology I, II and ICD9/10 knowledge
Precise attention to detail
Excellent verbal communication, collaboration, and written skills
Strong organizational and time management skills; handles multiple workstreams with deadlines simultaneously
Proficiency in Microsoft Office (Word, Excel);
Proficiency in claims administration systems such as Javelina, ESL or similar.
Better Benefits:

We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:
Medical, dental and vision benefits
Annual bonus
Parental Leave
Dependent care 100% match up to max allowable
PTO beginning on Day 1
Tuition reimbursement
Health work/life balance
Hybrid office schedule
401(k) plan with company match
Employee Assistance Program
On-site gym with personal trainer access
Life insurance and short term disability insurance
More About Roundstone

Headquartered in Rocky River, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and cleveland.com. We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings. Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.

Our Core Values
Live well: Be healthier and bring positive energy to all you do.
Work smarter: Get things done, better.
Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.

Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:
https://go.cultureindex.com/p/f3eNpwni6hi

Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.