Stop Loss Claims Specialist

Marsh McLennan

1d•$57,738 - $65,000•Hybrid

About The Position

The primary role of the Stop Loss Claims Analyst role is to manage the stop loss claims process for the MMA Stop Loss Center of Excellence including establishing the claims submission process in accordance with vendor processes, overall tracking and auditing to assure timely payment of eligible stop loss claims managed by the Center of Excellence.

Requirements

Minimal of High School Graduate with Associate’s Degree in Risk Management & Insurance, Actuarial Science, Mathematics and/or other related field is preferred or equivalent experience preferred
Minimum of two years prior work experience the Benefits Brokerage, Consulting, or Insurance industry
Strong background in self-funding, stop loss or claims administration required
Strong organizational, analytical skills and strong attention to detail
Excellent troubleshooting, decision making and problem solving skills
Proven ability to support multiple projects simultaneously with attention to detail and process
Ability to multi-task and work in a fast-paced environment
Excellent verbal and written communication skills
Ability to prioritize projects and meet deadlines
Ability to follow through on and successfully execute tasks while adhering to specified quality standards
Must be able to effectively interact with people internal and external customers
Intermediate knowledge of MS Office Suite (Word, Excel, Access, Outlook), working knowledge of pivot tables

Responsibilities

Partner with carriers and internal teams to establish as a preferred method automated file feeds with common identifiers when possible.
In situations where automated file feed exchanges are not possible work to confirm viability/alignment of each parties internal processes to assure required claims data can be shared at the agreed upon intervals and methods.
Collaborate with internal MMA Agency contacts to have the MMA Stop Loss Center of Excellence provided with the appropriate ongoing reporting or TPA/PBM system access to obtain reporting needed to support overall process.
Work with Trion Compliance and MMA Legal to execute any required Non-Disclosure Agreement, Confidentiality Agreement or related required Authorization that may be needed to either receive or have access to a portal containing claims data.
Perform analysis using established process/and or systems to combine data files from various vendors to determine overall total risk exposure to develop reporting to be delivered to the applicable MMA Agency for delivery or inclusion in their overall financial reporting process on a monthly basis.
Leverage the total risk exposure to assure stop loss vendor alignment on projected eligible and final paid claims to assure accurate and timely payment of eligible claims.
Work through any identified discrepancies including escalation of claims issue as appropriate.
Work with local MMA Agency team to assure any required documentation including eligibility, leave policies, required subrogation forms or alike are requested from the Client and provided back to the stop loss vendor to assure timely payment of eligible claims.
Send out reminder requests to all applicable TPAs to submit all eligible claims prior to the end of a plan or policy year in an effort to maximize all eligible stop loss reimbursements.
As requested by the Employer in coordination with the local MMA Agency team request as appropriate any interim bills.
Update management team on identified trends in stop loss market claims adjudication process and execution to be addressed as part of ongoing panel management conversations.
As capacity allows at the direction of the Director of the Stop Loss Center of Excellence provide claims coordination support for identified Trion accounts.
Maintain quality service standards and organization to assure timely service to Trion and MMA Agency teams.
Remain abreast of the dynamic, competitive insurance environment, new and complex insurance initiatives, appropriate data analysis techniques and constantly changing legislation that governs business.
Support other initiatives of the Strategic Initiatives Division and Underwriting Team as needed.