Stop Loss Coordinator

About the role

The Stop-Loss Coordinator is responsible for submitting stop-loss claims for high-cost claims and plans to the various carriers.

Responsibilities

• Track reimbursement claims and support finance for accurate payment reconciliation.
• Manage the monthly stop-loss ending process, including 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 the 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 stop-loss 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 core values of optimism, respect, intelligence, adaptability, and 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.