Stop Loss Coordinator

In this dynamic role, you will oversee the stop-loss insurance process, manage claims, coordinate with vendors, and ensure compliance with industry regulations. Your analytical mindset and industry knowledge will directly contribute to our clients' success and satisfaction.

Key Responsibilities

• Track & Report: Identify and report members who meet 50% or more of the specific deductible to our excess loss vendor.
• Data Management: Collect and submit all required documentation to request reimbursement for claims that exceed the specific deductible.
• Claim Processing: Review daily funding requests, track paid claims, and manage eligible claims submissions for stop-loss and advanced funding requests.
• Communication & Coordination: Act as the liaison between the excess loss vendor and internal teams, providing necessary data and responding to vendor inquiries.
• Audit & Reporting: Assist with monthly and year-end aggregate claim submissions, and support internal audits by providing necessary information.

What You'll Need to Succeed

• Analytical Mindset: Strong mathematical skills are essential for tracking claims and preparing reimbursement requests.
• Attention to Detail: You'll be responsible for managing high-cost claims, so accuracy is key.
• Highly Organized: Able to manage multiple tasks efficiently in a fast-paced environment.
• Team Player: Ability to work collaboratively across multiple departments and communicate effectively.
• Industry Knowledge: A background in accounting, medical billing, or banking is helpful, as well as familiarity with medical terminology. Experience with third-party administrators (TPAs) or health insurance carriers is strongly preferred.

• Education & Experience: Associate’s Degree or 2+ years of relevant work experience.
• Proficiency in MS Office: Solid experience with Microsoft Word, Excel, and Outlook.
• Industry Experience: Javelina claims processing, stop-loss insurance, and medical terminology.
• Retiree/Direct Billing programs, and premium collection services, as well as providing customized benefit solutions to businesses nationwide.