STOP LOSS ANALYST
About The Position
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. Communicate regularly with various departments, external vendors, clients, and carriers. Validates filing denials and prepares appeals when necessary, to ensure our clients are receiving the maximum reimbursement allowed under the policy.
Requirements
- Stop Loss Team experience
- Experience with stop loss claim filing
- Experience monitoring members approaching/exceeding spec
- Experience monitoring clients approaching/exceeding aggregate
- Experience generating and reviewing reports
- Experience gathering supporting documentation
- Experience compiling and submitting stop loss claim filings
- Experience managing claim filings through reimbursement
- Experience communicating with departments, vendors, clients, and carriers
- Experience validating filing denials
- Experience preparing appeals
Responsibilities
- Ensure timely reporting and stop loss claim filing with various stop loss carriers.
- Monitor members approaching/exceeding spec, including policies with advance funding.
- Monitor clients approaching/exceeding aggregate, including policies with accommodation.
- Generate various reporting and review for accuracy before distribution, both internally and externally, as assigned.
- Gather supporting documentation from both internal and external entities.
- Compile stop loss claim filings, including all supporting information/documentation, and submit to the stop loss carrier to maximize reimbursement.
- Manage filings through reimbursement, including consideration of policy filing limitations.
- Communicate regularly with various departments, external vendors, clients, and carriers.
- Validate filing denials and prepare appeals when necessary to ensure clients receive maximum reimbursement allowed under the policy.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
