Stop Loss Coordinator
Stop Loss Coordinator
The Stop-Loss Coordinator is responsible for submitting stoploss claims for high-cost claims and plans to the various carriers.
Duties/Responsibilities:
- Track reimbursement claims and support finance for accurate payment reconciliation.
- Manage the monthly stop loss ending process to include notification to appropriate interdepartmental teams, clients and/or brokers.
- Monitor and track total reimbursement dollars for clients and prepare reporting for internal and external customers.
- Prepare and submit claims for advance funding and/or reimbursement to the stop loss carrier.
- Research individual claim disputes and provide resolution.
- Interact with large case management and providers to secure patient prognosis and treatment plans.
- Interact with Account Managers to discuss opportunities to avert risk.
- Manage stop loss claims process: responsible for the entire stop loss claims process, from initial submission to final resolution, to ensure timely and accurate processing.
- Review reimbursements and coordinate with the Finance team for accurate payment reconciliation.
- Monitor pending submissions of stoploss claims and respond timely to carrier requests for additional information.
- Review and analyze stop loss policies to ensure understanding of the claims and reimbursement requirements by Carrier.
- Maintain documentation: Keep detailed and organized records of all stop loss claims, including supporting documentation and correspondence in accordance with Company policies and procedures.
- Analyze claims data and Carrier denials/requests for further information.
- Provide regular updates to Management regarding claim status, pending issues, and resolution timelines.
- Coordinate with internal teams when information is needed.
- Other duties as assigned.
Required Skills/Abilities:
- Knowledge of stop loss insurance.
- Strong organizational skills.
- Strong sense of professionalism and personal accountability.
- Working knowledge of Microsoft Office, particularly Excel.
- Strong communication skills.
- Alignment with our core values of optimism, respect, intelligence, adaptability, building long-term relationships.
Education and Experience:
- Minimum of 2 years of claims experience.
- Experience with administering self-insured health plans.
Physical Requirements:
Prolonged periods of sitting at a desk and working on a computer.
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Located in Feasterville-Trevose, PA, 19053
We look forward to receiving your application!
Please send an email to [email protected] and include a letter of interest and resume.
