Stop Loss Analyst

October 31

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Centivo

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health benefits • health insurance • value-based care • healthcare • healthcare provider networks

201 - 500 employees

Founded 2017

⚕️ Healthcare Insurance

Description

• Maintain a process for identifying potential specific claimants within each client’s utilization data including collaboration with other key departments to identify and monitor specific claimants in a timely fashion. • Manage specific and aggregate claim submission processes, acting as liaison between Centivo and its stop loss carrier partners including: • Ensuring new carriers have Non-Disclosure Agreements in place before sharing any client data. • Providing stop loss carrier with necessary information required for claim reimbursement consideration and appeal submissions. • Requesting changes to stop-loss policy and/or client SPD as needed to ensure seamless coverage. • Participating in internal workgroups and task force(s) as needed to successfully implement stop loss administration in claims system. • Collaborate with Sales Executives, Account Managers and/or other internal department(s) for the management of renewal quote requests. • Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement. • 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, client/product implementation planning as it may relate to stop loss management. • 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 • Knowledge of the claims/submission process

Benefits

• Offers Equity • Offers Bonus