Senior Stop Loss Specialist

Responsibilities

• Stop Loss Claims Management
• Compiles and submits stop loss claims to the carrier for reimbursement.
• Enters appropriate stop loss claims into designated database.
• Identifies, researches, and resolves stop loss carrier questions.
• Facilitates advancement funding with Finance Department.
• Complies with reporting and documentation requirements.
• Manages large case notifications process.

Quality Assurance

• Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving customer satisfaction.
• Recognizes, documents, and alerts appropriate supervisor of trends.
• Performs self-quality monitoring in order to develop and execute plans to meet established goals.
• Provides ongoing feedback to help optimize quality performance.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Develops new or improves current internal processes to improve quality.

Requirements

• High School Diploma or GED.
• 1+ years' experience in clerical and customer service.
• Knowledge of medical terminology.
• Working knowledge of computers and software including but not limited to Microsoft Office products.
• Proficient mathematical, 10-key and typing skills.
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented.
• Demonstrated ability to remain neutral and maintain confidentiality.
• Strong written and oral communication skills.
• Demonstrated ability to work independently, prioritize workloads multi-task and manage priorities in order to meet deadlines.