Provide subject matter expert (SME) level knowledge and stoploss reconciliation support for self-funded clients. Analyze claims data and produce accurate and timely stoploss case documentation. Work with clients and stoploss carriers to ensure that customer service inquiries are handled in a timely manner. Provide claims processing or adjustment processing support as assigned.
Work Experience: Three years health insurance or related experience preferred. Claims processing, customer service and business analysis experience is required. Marketing and/or stoploss administration experience is helpful. Requires high-level knowledge of medical terminology and ICD-10/CPT coding expertise.
Education, Certificates, Licenses: High school diploma or equivalent.
Knowledge: Demonstrates a thorough understanding of self-funded products, plan designs, and health insurance terminology. Ability to balance multiple projects and accomplish tasks accurately under pressure, determine priorities and meet deadlines. Must have the capacity to be self-motivated and to think and work independently. Ability to clearly communicate via written/verbal interactions with internal and external customers in a professional manner. Accountable for the quality and accuracy of all documents, files and records used to substantiate stoploss cases. Intermediate to advanced level PC skills, 10-key accuracy and Microsoft Excel, Word, and Outlook. Must be able to read and understand health contracts and stoploss requirements.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.