Medical Stop Loss Claims Auditor

Job overview

The Medical Stop Loss Claims Auditor role is onsite in Evanston, IL, with an annual salary of $75,000–$85,000. Evolution Risk Partners provides customizable medical stop-loss solutions for self-funded medical programs. This role audits and authorizes specific-claim reimbursements, verifies claims against plan documents and stop-loss contracts, and identifies cost-mitigation opportunities. It supports accurate claim decisions, reserve analysis, and responsive service to internal and external customers.

What you'll do

• Audit stop-loss claims against plan documents and contracts
• follow up on pending claims
• interpret plan language and contract provisions
• identify cost-mitigation opportunities
• refer claims for carrier review when needed
• analyze claims and large-claim reports to post or adjust reserves
• communicate with internal and external customers.

What we're looking for

Skills & competencies

medical stop loss

claims auditor

claims auditing

reinsurance

plan documents

stop-loss contracts

cost mitigation

claims analysis

excel

evanston il

evolution risk partners

annual salary $75k-$85k

Work arrangement

• Weekend coverage required

Benefits & perks

• Health, dental, and vision insurance
• 401(k) with matching
• employee assistance program
• flexible spending and health savings accounts
• life insurance
• flexible PTO and paid holidays
• wellness programs and discount programs.

Why this role

The posting also considers aggregate-claims auditing and captive experience relevant; a bachelor's degree is a plus.

About the employer

EVOLUTION RISK PARTNERS, LLC is hiring for this role. Industry: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. Sector: 52.