Stop Loss Claims Manager

HUB International•Atlanta, GA

2d•$52,000 - $55,000•Onsite

About The Position

A Stop-Loss Claims Manager oversees the administration, data collection, submission, and resolution of stop-loss insurance claims, ensuring accuracy, compliance, and timely processing for both Individual Stop Loss (ISL) and Aggregate Stop Loss (ASL). This role serves as a critical liaison between employers, third-party administrators (TPAs), brokers, and carriers, managing high-cost claims that exceed predetermined thresholds.

Requirements

Understanding of stop-loss insurance, medical claims, and healthcare regulations.
Strong analytical and decision-making skills (thinking outside the box).
Excellent communication skills.
Proficiency in Outlook, SalesForce, Excel and Data Analytics tools.
Ability to manage sensitive personal health information with discretion and professionalism.
2-5 years of relevant experience.

Responsibilities

Review, evaluate, and process complex stop-loss claims, ensuring they meet policy terms and conditions.
Analyze large-dollar claims for potential coverage issues, exclusions, and reimbursement eligibility.
Communicate with TPAs, brokers, and internal departments to gather necessary documentation and clarify claim details.
Ensure claims are handled in accordance with regulatory guidelines, contractual obligations, and internal standards.
Generate detailed reports on claim activity and recovery outcomes to support underwriting and finance teams.
Utilize a multitude of data analytics platforms.
Identify opportunities to streamline workflows, enhance claim accuracy, and improve turnaround times.
Provide collaboration and guidance to fellow team members, support training initiatives, and contribute to departmental strategy.