Stop Loss Specialist
Stop Loss Specialist
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Job Description
Overview
Now is the time to join us!
Were Personify Health. Were the first and only personalized health platform company to bring health wellbeing and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health we believe in offering total rewards flexible opportunities and a diverse inclusive community where every voice matters. Together were shaping a healthier more engaged future.
Responsibilities
Who are you
The Stop Loss Specialist is responsible for supporting the coordination and filing of Specs Advance Funding and Plan Year End Closeouts. The incumbent is expected to communicate professionally with peers supervisors subordinates market customers and the public and be respectful and courteous in the conduct of this position.
In this role you will wear many hats but your knowledge will be essential in the following:
- Prepare Stop Loss claims and applicable documents to determine Stop Loss filing eligibility applicable to the Excess Loss Policy.
- Files submissions of spec claimants (running reports gathering necessary documents and email correspondence) processing all submissions within established internal timeframes.
- Coordinate Advanced Funding Requests with the client and the Stop Loss carrier.
- Maintains database of all specific reimbursement requests.
- Creates initial Specific File for each claimant files all submissions in our EDOCS platform.
- Coordinates the release of Over Specific System Hold on hold claims.
- Acts as the liaison between the PBMs and internal clients as it pertains to our Stop Loss claimants.
- Keeps immediate supervisor apprised of open or disputed items.
- Contributes to daily workflow with regular and punctual attendance.
- Performs related or other assigned duties as required or directed.
- Monitors all reinsurance requests to ensure receipt of reimbursement.
- Generates weekly outstanding reimbursement report and follows up with the Stop Loss carrier.
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Qualifications
What you bring to the Personify Health team:
In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
- High school diploma or general education degree (GED) required.
- Knowledge of medical terminology
- Strong written and verbal communication skills
- Proficient in Word Excel and outlook
- Ability to organize prioritize and multitask in a fastpaced environment
- Demonstrate ability to work independently with excellent judgment
- A detailoriented analytical financially minded approach
You also take pride in offering the following Core Skills Competencies and Characteristics:
- Must be computer literate and knowledgeable in Windows and Microsoft Office environment including Word Excel and Outlook.
- Knowledge of insurance database system a plus.
- Ability to read analyze and interpret common financial reports and legal documents.
- Ability to respond to common inquiries or complaints from customers regulatory agencies or members of the business community.
- Ability to effectively present information to top management public groups and/or boards of directors.
- Ability to work with mathematical concepts such as probability and statistical inference.
- Ability to apply concepts such as fractions percentages ratios and proportions to practical situations.
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Ability to interpret a variety of instructions furnished in written oral diagram or schedule form.
No candidate will meet every single desired qualification. If your experience looks a little different from what weve identified and you think you can bring value to the role wed love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity inclusion equity and social justice.
In compliance with all states and cities that require transparency of pay the base compensation for this position ranges from $17.00 to $20.00 per hour. Note that compensation may vary based on location skills and experience. This position is eligible for health dental vision mental health and other benefits.
We strive to cultivate a work environment where differences are celebrated and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity Equity Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level) members clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.
#WeAreHiring #PersonifyHealth
Beware of Hiring Scams:Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications please report them totalent@personifyhealth.com. All of our legitimate openings can be found on the Personify HealthCareer Site.
Application Deadline: Open until position is filled.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
