Stop Loss Specialist/ RFP Reporting Analyst:
This position coordinates the tracking, monitoring, documenting and submission of stop loss claims. This position coordinates the Stop Loss Renewal RFP process and assists with underwriting administration for Captive and MGU. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.
Essential Duties and 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 documentations requirements.
- Manages large case notifications process.
- Stop Loss Renewals/RFP Administration
- Prepares and organizes renewal files each month.
- Coordinates and runs renewal reports each month.
- Sends renewal package out to bid to carriers and brokers.
- Files incoming quotes and sends on to Account Manager
- Prepares Disclosure package when required.
- Captive and MGU Underwriting Administration
- Assist Underwriters as assigned
- Sort and enter RFP Data (internal and external) in appropriate systems, including health statements, claims history, census data, and catastrophic situations
- Assist Sales Team, Underwriters and brokers with RFP process
- Coordinate submission of health statements for reporting
- Customer Service
- Acts as a role model in demonstrating the core values in customer service delivery.
- Provides timely and thorough follow up with internal and external customers.
- Appropriately escalates difficult issues up the chain of command.
- Trains new employees as assigned.
- 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.
- This job description in no way states or implies that these are the only duties to be performed by this employee. The employee will be required to follow any other instructions and to perform any other duties requested by his/her supervisor.
- High school diploma or equivalent
- Associates degree in Medical Billing and Coding or related field preferred
- Minimum of two years experience in clerical and customer service
- Strong working understanding of Third Party Administration preferred
- Claims or Medical Office experience preferred
- Knowledge of medical terminology is preferred
- 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
Physical Demands & Working Conditions:
Work is indoors in an office environment with moderate noise. Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required. A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time. Approximately 30% or less of the time is spent standing. Normal vision abilities required, including close vision and ability to adjust focus.
EBMS is and EEO/AA/M/F/Vet/Disability Employer.
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