STOP LOSS ANALYST

Job Responsibilities

This position works as part of the Stop Loss Team to ensure timely reporting and stop loss claim filing with the various stop loss carriers.

• Monitors members approaching/exceeding spec, including policies with advance funding.
• Monitors clients approaching/exceeding aggregate, including policies with accommodation.
• Generates various reporting and reviews for accuracy before distribution, both internally and externally, as assigned.
• Gathers supporting documentation from both internal and external entities.
• Compiles stop loss claim filings, to include all supporting information/documentation, and submits to the stop loss carrier to maximize reimbursement.
• Manages filings, through reimbursement, to include consideration of policy filing limitations.
• Communicates regularly with various departments, external vendors, clients, and carriers.
• Validates filing denials and appeals when necessary, to ensure our clients are receiving the maximum reimbursement allowed under the policy.

Qualifications

• High school diploma or equivalent.
• 2 years of experience in stop-loss claims and/or auditing would be preferable but would substitute additional experience processing medical claims.
• Experience with various specific and aggregate policy contracts preferred.
• Ability to analyze detailed reports and validate accuracy of the data.
• Experience in Microsoft Outlook, Word and Excel.
• Time management skills and the ability to adhere to deadlines.
• Good verbal and written communication skills.
• Ability to maintain regular attendance.
• Ability to maintain confidentiality of material and information.
• Ability to maintain professional appearance and demeanor.
• Ability to work independently with minimal supervision.

Demonstrate problem-solving and decision-making skills and be adaptable in a changing environment