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Stop Loss Claim Auditor

Valenz • Remote, US • published 2026-11-10 06:59:56.067018

Description

Remote Full Time 4010 \- Certus Operations Mid Level Vālenz Health® is the destination for employers, brokers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience. Through advanced technology and clinical expertise, Valenz creates a distinctly different approach to a complex healthcare system. With our solutions, we execute across the entire healthcare journey — from member experience to payment integrity, provider quality, and plan performance. With one of America’s largest cost, quality and utilization datasets, we create greater transparency, flexibility, and cost containment — empowering members and employers with the information they need to make smarter, more cost\-effective decisions. **About This Opportunity:** As a Stop Loss Claim Auditor, you’ll review and audit stop loss reimbursement requests to ensure accurate and timely payments in accordance with plan documents, stop loss policies, contractual requirements, and established procedures. You’ll evaluate supporting claim and eligibility documentation, perform aggregate claim calculations within your delegated authority, and help ensure reimbursement requests meet applicable requi...

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