Stop Loss Coordinator

POSITION SUMMARY:

The Stop Loss Coordinator is responsible for all stop loss processes and reporting. The role will manage the stop loss claims for reimbursement while providing the necessary reporting to carriers and clients. This position also works closely with other departments to coordinate funding of stoploss claims and distributes reimbursements once received from the carriers.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Prepare and file specific and aggregate claims under the clients stop loss policies and process reimbursements as they are received.
• Monitor pending submissions of specific and aggregate claims and respond to carrier requests for additional information.
• Support Finance Operations with the advance funding process.
• Notify internal staff of groups with expiring stop loss contracts and assist with monitoring outstanding claim and fee payments to ensure coverage under the specific or aggregate.
• Maintain group policy configuration in claims system based upon new group and renewal notification.
• Review stop loss contracts to ensure they match the group notifications.
• Monitor monthly aggregate claim levels and submit specific and aggregate reports to carriers monthly.
• Assist with stop loss carrier audits and report audit findings to management.
• Assist with new group and new carrier implementation processes.
• Perform other duties and responsibilities as assigned.

QUALIFICATIONS:

• Detail oriented and quality assurance focused.
• Strong problem-solving and analytical skills with a proactive mindset.
• Highly motivated and a self-starter that is resourceful and adept at getting the job accomplished with a sense of urgency.
• Proficiency in project plan management and the ability to problem-solve and manage multiple time-sensitive projects are required.
• Ability to work independently and as part of a cross-functional team.
• Commitment to operational excellence security and regulatory compliance.
• Focus on continuous improvement learning and adapting to new technologies.
• Strong negotiation skills in both internal and external settings.
• Excellent written and verbal communication skills.

EDUCATION AND/OR EXPERIENCE:

• An associates degree or equivalent with a preference for a degree in business administration or health related field.
• 1-3 years of experience in a stop loss coordinator role administering excess stop loss arrangements.
• Ability to read and interpret stop loss policies and benefit plan documents.

COMPETENCIES:

The Stop Loss Coordinator should continue to develop the following competencies with an attitude of being a lifelong learner in the fields of healthcare and business:

Sales and Marketing Knowledge of principles and methods for showing promoting and selling services. This includes sales strategy and tactics services demonstration and proposal writing.

Developing Objectives and Strategies Establishing long-range objectives and specifying the strategies and actions to achieve them.

Member and Personal Service Knowledge of principles and processes for providing member and personal services. This includes member needs assessment meeting quality standards for services and evaluation of member satisfaction.

Developing and Building Teams Encouraging and building mutual trust respect and cooperation among team members.

Communicating with Internal and External Partners Providing information to partners within and outside the organization by telephone in written form e-mail and in person. Also includes representing the organization to members the public and other external sources.

Administration and Management Knowledge of business and management principles involved in strategic planning resource allocation human resources modeling leadership technique and coordination of people and resources

Critical Thinking Using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions and approaches to problems.

Complex Problem Solving Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Analyzing Data or Information Identifying the underlying principles reasons and facts of information by breaking down information and data into separate parts.

Organizing Planning and Prioritizing Work Developing specific goals and plans to prioritize organize and accomplish your work.

Fluency of Ideas The ability to come up with several ideas about a topic (the number of ideas is important not their quality correctness and creativity).

Active Listening Giving full attention to what other people are saying taking time to understand the points being made asking questions as appropriate and not interrupting at inappropriate times.

Problem Sensitivity The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem only recognizing there is a problem.

Establishing and Maintaining Interpersonal Relationships Developing constructive and cooperative working relationships with others and maintaining them over time.

Law and Government Knowledge of laws legal codes and government regulations.

Evaluating Information to Determine Compliance with Standards Using relevant information and individual judgment to determine whether events and processes comply with laws regulations and standards.

Organization Prioritizing workflows based upon client needs deadlines (internal and external) and available resources; being capable of managing multiple projects at one time.

Judgment and Decision Making Considering the relative costs and benefits of potential actions to choose the most appropriate one.

Inductive Reasoning The ability to combine pieces of information to form general rules and conclusions (includes finding a relationship among seemingly unrelated events).

Deductive Reasoning The ability to apply general rules to specific problems to produce answers that make sense.

Making Decisions and Solving Problems Analyzing information and evaluating results to choose the best solution and solve problems.

Updating and Using Relevant Knowledge Keeping up-to-date technically and applying new knowledge to your job.

Written Expression The ability to communicate information and ideas in writing so others will understand.

Written Comprehension The ability to read and understand information and ideas presented in writing.

Oral Expression The ability to communicate information and ideas verbally so others will understand.

Oral Comprehension The ability to listen to and understand information and ideas presented verbally.

Monitoring Monitoring/Assessing performance of yourself other individuals and organizations to make improvements and take corrective action.

Mathematics Knowledge of arithmetic algebra statistics and their applications.

COMPUTER SKILLS:

To perform this job successfully an individual should have advanced proficiency in all Microsoft Office products and be able to learn new systems within a reasonable time.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is regularly required to stand walk use hands and fingers talk and hear. The employee is frequently required to sit and reach with hands and arms. The employee is occasionally required to climb or balance and stoop kneel crouch or crawl. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move 25 pounds or more. Specific vision abilities required by this job include close vision distance vision peripheral vision depth perception and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The employee will work primarily in an office environment during typical office hours with occasional overtime; the office environment has moderate temperatures and minimal noise levels. Regular travel of approximately 10-20% by car and airplane may be required. The employee will occasionally tour client facilities that may be inside or outside and where climbing may be required temperatures may be extreme and dirt vibration and noise levels may be high.

ADDITIONAL COMMENTS:

This job description is not intended to be a complete list of all responsibilities duties or skills required for the job and is subject to review and change at any time with or without notice in accordance with the needs of Vitori Health LLC. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job duties and responsibilities that may be inherent in a job reasonably required for its performance or required due to the changing nature of the job shall also be considered part of the jobholders responsibility.

POSITION SUMMARY:

The Stop Loss Coordinator is responsible for all stop loss processes and reporting. The role will manage the stop loss claims for reimbursement while providing the necessary reporting to carriers and clients. This position also works closely with other departments to coordinate funding of stoploss claims and distributes reimbursements once received from the carriers.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Prepare and file specific and aggregate claims under the clients stop loss policies and process reimbursements as they are received.
• Monitor pending submissions of specific and aggregate claims and respond to carrier requests for additional information.
• Support Finance Operations with the advance funding process.
• Notify internal staff of groups with expiring stop loss contracts and assist with monitoring outstanding claim and fee payments to ensure coverage under the specific or aggregate.
• Maintain group policy configuration in claims system based upon new group and renewal notification.
• Review stop loss contracts to ensure they match the group notifications.
• Monitor monthly aggregate claim levels and submit specific and aggregate reports to carriers monthly.
• Assist with stop loss carrier audits and report audit findings to management.
• Assist with new group and new carrier implementation processes.
• Perform other duties and responsibilities as assigned.

QUALIFICATIONS:

• Detail oriented and quality assurance focused.
• Strong problem-solving and analytical skills with a proactive mindset.
• Highly motivated and a self-starter that is resourceful and adept at getting the job accomplished with a sense of urgency.
• Proficiency in project plan management and the ability to problem-solve and manage multiple time-sensitive projects are required.
• Ability to work independently and as part of a cross-functional team.
• Commitment to operational excellence security and regulatory compliance.
• Focus on continuous improvement learning and adapting to new technologies.
• Strong negotiation skills in both internal and external settings.
• Excellent written and verbal communication skills.

EDUCATION AND/OR EXPERIENCE:

• An associates degree or equivalent with a preference for a degree in business administration or health related field.
• 1-3 years of experience in a stop loss coordinator role administering excess stop loss arrangements.
• Ability to read and interpret stop loss policies and benefit plan documents.

COMPETENCIES:

The Stop Loss Coordinator should continue to develop the following competencies with an attitude of being a lifelong learner in the fields of healthcare and business:

Sales and Marketing Knowledge of principles and methods for showing promoting and selling services. This includes sales strategy and tactics services demonstration and proposal writing.

Developing Objectives and Strategies Establishing long-range objectives and specifying the strategies and actions to achieve them.

Member and Personal Service Knowledge of principles and processes for providing member and personal services. This includes member needs assessment meeting quality standards for services and evaluation of member satisfaction.

Developing and Building Teams Encouraging and building mutual trust respect and cooperation among team members.

Communicating with Internal and External Partners Providing information to partners within and outside the organization by telephone in written form e-mail and in person. Also includes representing the organization to members the public and other external sources.

Administration and Management Knowledge of business and management principles involved in strategic planning resource allocation human resources modeling leadership technique and coordination of people and resources

Critical Thinking Using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions and approaches to problems.

Complex Problem Solving Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Analyzing Data or Information Identifying the underlying principles reasons and facts of information by breaking down information and data into separate parts.

Organizing Planning and Prioritizing Work Developing specific goals and plans to prioritize organize and accomplish your work.

Fluency of Ideas The ability to come up with several ideas about a topic (the number of ideas is important not their quality correctness and creativity).

Active Listening Giving full attention to what other people are saying taking time to understand the points being made asking questions as appropriate and not interrupting at inappropriate times.

Problem Sensitivity The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem only recognizing there is a problem.

Establishing and Maintaining Interpersonal Relationships Developing constructive and cooperative working relationships with others and maintaining them over time.

Law and Government Knowledge of laws legal codes and government regulations.

Evaluating Information to Determine Compliance with Standards Using relevant information and individual judgment to determine whether events and processes comply with laws regulations and standards.

Organization Prioritizing workflows based upon client needs deadlines (internal and external) and available resources; being capable of managing multiple projects at one time.

Judgment and Decision Making Considering the relative costs and benefits of potential actions to choose the most appropriate one.

Inductive Reasoning The ability to combine pieces of information to form general rules and conclusions (includes finding a relationship among seemingly unrelated events).

Deductive Reasoning The ability to apply general rules to specific problems to produce answers that make sense.

Making Decisions and Solving Problems Analyzing information and evaluating results to choose the best solution and solve problems.

Updating and Using Relevant Knowledge Keeping up-to-date technically and applying new knowledge to your job.

Written Expression The ability to communicate information and ideas in writing so others will understand.

Written Comprehension The ability to read and understand information and ideas presented in writing.

Oral Expression The ability to communicate information and ideas verbally so others will understand.

Oral Comprehension The ability to listen to and understand information and ideas presented verbally.

Monitoring Monitoring/Assessing performance of yourself other individuals and organizations to make improvements and take corrective action.

Mathematics Knowledge of arithmetic algebra statistics and their applications.

COMPUTER SKILLS:

To perform this job successfully an individual should have advanced proficiency in all Microsoft Office products and be able to learn new systems within a reasonable time.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is regularly required to stand walk use hands and fingers talk and hear. The employee is frequently required to sit and reach with hands and arms. The employee is occasionally required to climb or balance and stoop kneel crouch or crawl. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move 25 pounds or more. Specific vision abilities required by this job include close vision distance vision peripheral vision depth perception and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The employee will work primarily in an office environment during typical office hours with occasional overtime; the office environment has moderate temperatures and minimal noise levels. Regular travel of approximately 10-20% by car and airplane may be required. The employee will occasionally tour client facilities that may be inside or outside and where climbing may be required temperatures may be extreme and dirt vibration and noise levels may be high.

ADDITIONAL COMMENTS:

This job description is not intended to be a complete list of all responsibilities duties or skills required for the job and is subject to review and change at any time with or without notice in accordance with the needs of Vitori Health LLC. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job duties and responsibilities that may be inherent in a job reasonably required for its performance or required due to the changing nature of the job shall also be considered part of the jobholders responsibility.