Examiner - Stop Loss

Symetra offers a thrilling chance to become part of our team as an Examiner – Stop Loss! About the role Audit Individual Excess Loss claim submissions by analyzing excess loss policy provisions, employer plan document provisions, administrative agreements, and cost containment vendor agreements to ensure accurate claim reimbursements payable to the policyholder. Review potential claim notices and submissions for cost containment options and refer to Medical Risk Consultants or Cost Containment specialists. What you will do Review and decide on reimbursement of excess loss claims following the terms outlined in the Policyholder's Plan Document and Excess Loss Policy. Process claim reimbursements within established turnaround time targets. Sustain more than 99% accuracy in claim handling and financial correctness, including necessary documentation of relevant claimant, plan, and policy details. Maintain current pending claims with consistent follow-up, documentation, and resolution or closure within defined timeframes. Interact with TPA contacts and other resources to clearly communicate information needed to make reimbursement decisions. Provide timely turnaround when requested information is received for reimbursement or denial. Review advance notices of potential claims to identify and refer cases encouraged to become excess loss claims, needing MRC attention for renewal information or cost containment. Alert MRCs, RGMs, and Underwriters of possible catastrophic claims risk as well as unusual and complex claim issues. Interact with internal and external customers responding to inquiries, handling appeals, facilitating claim resolutions, and providing and acquiring education in industry claim trends and cost containment solutions. Undertake special projects as identified by management. Why Work at Symetra Here’s what some of our employees share about why they choose to work at Symetra: “I chose Symetra because I heard it was a pro-employee company—and it’s absolutely true. The work environment is supportive, the people are great, and the benefits are generous. Symetra truly cares about its employees. The relaxed atmosphere and opportunities to learn and grow—both within your role and beyond—make it a great place to build your career.” - Alicia L., Claims Examiner What we offer you Benefits and Perks We don’t take a “one-size-fits-all” approach when it comes to our employees. Our programs are built 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. Compensation Hourly Range: $24.62 - $41.04 plus eligibility for annual bonus program. Who You Are High school diploma or equivalent work experience, college degree a plus. 1-3 years of cumulative, relevant experience Audit and bill review experience is a plus Aggregate experience is a plus Medical procedure terminology required Proficiency with Excel We empower inclusion At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute. Inclusion is about recognizing our assumptions, considering multiple perspective, 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 financial freedom 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. 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. Identity Verification Symetra is committed to fair and secure hiring practices. For all roles, candidates will be required (after the initial phone screen) to be on video for all interviews. Symetra will take affirmative steps at key points in the process to verify that a candidate is not seeking employment fraudulently, e.g. through use of a false identity. Failure to comply with verification procedures may result in: Disqualification from the recruitment process Withdrawal of a job offer Termination of employment and other criminal and/or civil remedies, if fraud is discovered