Stop Loss Coordinator

Wellnet; Feasterville-Trevose (Bucks County); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare solutions provider in Feasterville-Trevose is seeking a Stop-Loss Coordinator responsible for managing the entire stop loss claims process for high-cost claims. The ideal candidate will have a minimum of 2 years experience in claims, strong organizational skills, and knowledge of stop loss insurance. Responsibilities include tracking claims, preparing reports, and ensuring timely resolutions. This role requires strong analytical skills and the ability to interact effectively with internal and external stakeholders.

Responsibilities

• Track reimbursement claims and support finance for accurate payment reconciliation.
• Manage the monthly stop loss ending process with appropriate notifications.
• Monitor and track total reimbursement dollars for clients and prepare reporting.
• Prepare and submit claims for advance funding to stop loss carrier.
• Research individual claim disputes and provide resolutions.

Skills

Knowledge of stop loss insurance

Strong organizational skills

Strong sense of professionalism and personal accountability

Working knowledge of Microsoft Office, particularly Excel

Alignment with core values

Education

Minimum of 2 years of claims experience

Experience with administering self-insured health plans

Job description

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

Duties/Responsibilities:

• Track reimbursement claims and support finance for accurate payment reconciliation.
• Manage the monthly stop loss ending process to include 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 stop loss claims process: responsible for the entire 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 stoploss 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.
• Alignment with our core values of optimism, respect, intelligence, adaptability, 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.

Located in Feasterville-Trevose, PA, 19053

We look forward to receiving your application!
Please send an email to [e-mail] and include a letter of interest and resume.