Job Description:

*New hires must be fully vaccinated against the COVID-19 virus by the date of hire, unless granted an accommodation for a qualified medical or religious vaccine exemption.

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We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Overview

The Stop Loss Coordinator shall be responsible for operational support functions to include client annual reporting, analytical reporting, benefit analysis, and various internal reports in accordance with each Client's specific Stop Loss policy. The Coordinator is responsible to maintain goals in accuracy, productivity, and timeliness. The Coordinator is responsible to respond to internal customer inquiries from internal departments including, but not limited to, Client Services, Claims Operations, Customer Service, and Sales on claim status related to Stop Loss policies. The Coordinator will be responsible to accurately identify operational Stop Loss issues and offer sound recommendations for resolution as required. The Stop Loss Coordinator will be responsible to work independently and maintain workflow with minimal supervision and demonstrate problem-solving and decision-making skills.

Qualifications

• High School Diploma or GED required. Associates Degree preferred.




• Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services required. Self-funded healthcare experience preferred.




• Knowledge of Self-Funded Insurance and Stop Loss insurance preferred.




• Demonstrated ability to meet performance goals, including accuracy and productivity.




• Working knowledge of medical and dental benefit designs and interpretations.




• Excellent written, verbal, and interpersonal communication skills.




• Knowledge of negotiation strategies related to healthcare claims.




• Effective organizational and time management skills. Must be able to work independently without supervision and have demonstrated experience in exercising appropriate decision making. Exhibits initiative and self-motivation, with ability to effectively solve problems as they arise.




• Computer knowledge including advanced Word and Excel skills. Formulas and formatting skills are required.




• Proven examples of displaying Nova's Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.

Essential Accountabilities

Claims Negotiations

• Negotiate claim reimbursement based on clients plan document and policies and procedures.




• Analyze problems systematically, organizes information, identify underlying causes and generate solutions while recognizing the impact on stakeholders and the organization.




• Identify, analyze, track and interpret medical records and reimbursement.




• Evaluate claim potential and identify high dollar risks.

Reporting

• Develop and prepare reports for the client and/or stop loss carrier. These include aggregate Stop Loss reports, specific (50%) stop loss reports and Stop Loss Notifications.




• Facilitate production of ad hoc reports, when requested.




• 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.

Communication

• Effective written, verbal, and interpersonal communication skills to communicate clearly and confidently to internal and external customers.




• Work collaboratively with cross functional teams.




• Demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated.




• Designated contact person for all issues relating to stop loss for assigned groups, both internally and externally to include coordination of interdepartmental process when necessary (e.g. advance funding processes, special claim handling, check runs, check pulls).




• Follow-up as needed on all stop loss filings and communicate with the client, broker and/or stop loss carrier as necessary.




• Prepare and submit claims for advance funding and/or reimbursement to the stop loss carrier.




• Research individual claim disputes and provide resolution.




• Responsible for internal and external customer satisfaction in the resolution of claim specific issues.




• Maintain record of reimbursement check disbursement and route reimbursements back to the client.




• Track and manage, on a timely basis, the eligibility of claims based on the clients plan document to ensure accurate reimbursement or denial of a claim.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.