Excess Loss Analyst

POSITION SUMMARY

The Excess Loss Analyst manages Stop Loss insurance contracts for our clients. Key responsibilities include tracking monthly reports, submitting required claims documentation, coordinating funding requests, and preparing reports to help with contract renewals.

EXAMPLES OF DUTIES

• Monitor Claims: Review weekly claims activity to identify those eligible for Stop Loss reimbursement based on specific client contracts, using company-provided tools.
• Manage Contract Data: Stay current on changes to Stop Loss contracts and update our internal tracking systems to ensure accurate reporting.
• Submit Documentation: File timely notices and claims submissions when eligible cases arise, including coordinating with the Medical Management team.
• Track Finances: Monitor claim submissions and receipt of Stop Loss funds.
• Reporting: Prepare and distribute monthly reports and renewal documentation to Stop Loss carriers.
• Cooking Funding: Work with the Claims Department to request advance funding and release claims once payments are received.
• External Collaboration: Partner with outside vendors for subrogation and COBRA-related tasks.
• Internal Advocacy: Serve as an internal point of contact for Stop Loss questions or issues, collaborating with other departments as needed.
• Guide Additional Tool Enchancements: Work with the team to identify improvements for our internal analytical tools.

QUALIFICATIONS

• Core Requirements (Must-Haves): Experience: 3–5 years of claims handling or related TPA (Third-Party Administrator) experience. Technical Aptitude: Ability to learn reinsurance practices, interpret complex Stop-Loss contracts, and understand internal claims processing and Medical Management activities. Data Security: Ability to securely handle Protected Health Information (PHI) and manage encrypted electronic file transfers. Soft Skills: Strong analytical problem-solving skills, excellent written/verbal communication, and the ability to work both independently and collaboratively within a team. Software: Proficiency with Microsoft Office and/or Google Workspace products.
• Preferred Qualifications (Nice-to-Haves): Education: Bachelor’s degree preferred. Background: Proven organizational and research skills with a strong attention to detail; a background in mathematics or auditing is highly preferred. Industry Knowledge: Familiarity with medical terminology and standard coding formats (including CPT and ICD-9/ICD-10).

ABOUT FIRST CHOICE HEALTH

First Choice Health, headquartered in Seattle, WA, is a provider-owned healthcare organization offering employers a forward-thinking alternative to traditional health insurance. We have been serving employers of all sizes and across many industries with exceptional health benefits administration for over 35 years, providing unparalleled access to a growing number of clinically integrated networks (CIN) and a traditional PPO. Alongside our Employee Assistance Program (EAP) addressing mental health and work-life balance, our services collectively support members in every step of their healthcare journeys. At First Choice Health, we are proud to deliver the personalized, quality service our clients deserve, while reducing costs and keeping their members healthy.

OUR PURPOSE, VALUES & CULTURE

• CARE TRANSPARENT COLLABORATE RELENTLESS INNOVATE

PHYSICAL REQUIREMENTS

Ability to sit for long periods of time. Ability to see and hear within normal ranges, with or without aids. Ability to speak clearly. Hand and finger dexterity within normal ranges. Access to PHI: Routine & re-occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI.

BENEFITS

• Health & Insurance: Medical (HSA and PPO plans) and Vision coverage, Dental plan, employer-provided Life Insurance, and Short- & Long-Term Disability coverage.
• Financial & Retirement: Health Savings Account (HSA) with company contributions, Flexible Spending Account (FSA), 401(k) plan with an employer match, and discretionary Profit Sharing.
• Time Off & Development: Paid Time Off (PTO) accrued based on tenure, Paid Holidays (including floating holidays and time for community service), and Tuition Reimbursement for continuing education.
• Support: Employee Assistance Program (EAP) for confidential professional counseling, and a Wellness program with rewards.