Stop Loss Coordinator

Wellnet Enerji

Tohatchi (NM)

On-site

USD 55,000 - 75,000

Full time

13 days ago

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Job summary

WellNet is seeking a Stop Loss Coordinator to manage end-to-end stop loss claims and related reporting. You will coordinate with finance, carriers, and account teams to ensure timely, accurate processing and transparent communication.

Ideal candidates have 2+ years of claims experience, familiarity with self-insured health plans, and strong organizational and Excel skills. This on-site role is based in Feasterville-Trevose, PA, and emphasizes accountability and professional client service.

Qualifications

Minimum of 2 years of claims experience.
Experience with administering self-insured health plans.

Responsibilities

Track reimbursement claims and support finance for accurate payment reconciliation.
Manage the monthly stop loss ending process and notify relevant teams.
Monitor total reimbursement dollars and prepare client/partner reports.
Prepare and submit claims for advance funding or reimbursement to carriers.
Research claim disputes and provide resolution.
Interact with large case management and providers on prognosis and treatment plans.
Coordinate with Account Managers to discuss risk mitigation.
Maintain complete stop loss documentation and records.

Skills

Stop loss insurance

Organizational skills

Professionalism

Microsoft Excel

Communication skills

Accountability

Job description

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Stop Loss Coordinator

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.
Strong communication skills.
Alignment with our core values of optimism, respect, intelligence, adaptability, building long-term relationships.

Education And Experience