Job Description

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.

Qualifications