Stop-Loss Coordinator

Health Plans Inc

13h • Onsite

About The Position

Health Plans, Inc. (HPI) is a New England-based Third-Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities, and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security. This position will provide administrative support to the Reinsurance Department.

Requirements

• Two or more years of experience in administrative, claims, benefits, insurance, or healthcare office environment handling documentation, records, and/or financial transactions
• Prior experience working within established procedures and escalation protocols
• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Nice To Haves

• Communicate effectively, both verbally and in writing
• Ability to work both independently and as a team member
• Must be detail oriented, analytical and accurate
• Recognize the need for follow-thru and follow-up
• Ability to work within specified timeframe and meet deadlines
• Experience working with confidential or sensitive information
• Experience in a regulated or compliance-driven environment

Responsibilities

• Request and gather enrollment documentation, active at work status forms, and other insurance information for members based on stop loss activity
• Generate other insurance correspondence to members based on stop loss activity
• Retrieve and compile claim copies, invoice backup, itemized bills and member correspondence as needed to support stop loss filings, carrier requests, and internal reviews
• Perform timely follow-up within established timeframes and escalate missing or incomplete documentation, referring unresolved items to the Stop Loss Specialist or leadership team to prevent delays, denials, or compliance risk
• Preparing and complete Explanation of Reimbursement (EOR) journal entries ensuring accuracy and timeliness
• Identify and refer any pends or denials noted on EOR(s) to the Stop Loss Specialist for review, resolution, and follow-up
• Prepare letters and summaries to accompany EOR(s) and checks for internal and external communication
• Maintain the carrier refund log, prepare cover letters and forward refund checks to carriers as required
• Maintain accurate records and logs of completed stop loss support activities in accordance with departmental standards
• Adhere to confidentiality requirements and ensure compliance with internal policies and regulatory standards

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED