Stop Loss Analyst

Role Overview

• Maintain a process for identifying potential specific claimants within each client’s utilization data
• Manage specific and aggregate claim submission processes, acting as liaison between Centivo and its stop loss carrier partners
• Ensure new carriers have Non-Disclosure Agreements in place before sharing any client data
• Provide stop loss carrier with necessary information required for claim reimbursement consideration and appeal submissions
• Request changes to stop-loss policy and/or client SPD as needed to ensure seamless coverage
• Participate in internal workgroups and task force(s) as needed to successfully implement stop loss administration in claims system
• Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement
• Create and deliver monthly reports to carriers, including Aggregate Accommodations and Year-End Aggregate Filings
• Schedule and automate recurring reporting tasks to meet internal and carrier-specific goals
• Generate timely and accurate financial data for monthly report submissions
• Proactively reviews weekly reports to identify potential high-cost claimants
• Participate actively in team and department meetings on stop loss administration process and client/product implementation planning
• Ensure stop loss industry knowledge is current, bringing forward ideas and recommendations to ensure Centivo has competitive position in the marketplace
• Convey renewal information for stop-loss rates internally within Centivo
• Utilize developed understanding of all aspects of operational functions to efficiently perform to the established service standards as related to renewals and client service
• Elevate client issues and concerns to appropriate Manager, Client Services and/or Account Management
• Performs other miscellaneous projects, assignments, and duties as assigned by management

Requirements

• 4 years of experience in stop loss, claims operations, financial analytics, customer service, or client services required
• Associates degree required; Bachelor’s degree preferred
• Stop Loss policy management and marketing experience required, specifically with self-funded insurance, level-funded based client knowledge
• Knowledge of the claims/submission process
• Advanced knowledge of Microsoft Office products (Excel, Power Point, Word)
• Strong customer service, organizational and time management skills
• Demonstrated ability to meet performance goals, including accuracy and productivity
• Excellent written, verbal, and interpersonal communication skills
• Ability to access, operate, and maintain various software applications
• Ability to work independently with minimal supervision
• Strong interpersonal skills, establishing rapport and working well with others

Benefits

• Offers Equity
• Offers Bonus