Stop Loss Analyst

This position reports to the Claims Manager and will be responsible for generating monthly Stop Loss Reports, coordinate the tracking, monitoring, documenting and submission of stop loss claims.

Responsibilities:

• Follow stop loss contracts, procedures, and guidelines
• Monthly reporting
• Research, review and manage all carrier request timely
• Establish and maintain relationships with carriers, vendors, and internal teams
• Manage correspondence from carriers
• Continual growth of knowledge in an ever-changing environment
• Create and maintain a positive working relation with reinsurance carriers
• Create and maintain department policy and procedures

Teamwork:

• Work cooperatively with other team members
• Actively participate in team meetings and training activities
• Perform additional responsibilities and projects as periodically assigned

Education/Certification:

• High School Diploma/GED
• Three (3) years recent experience analyzing medical claims
• Previous Stop Loss experience (Preferred)

Skills/Abilities:

• Extensive knowledge of medical terminology, CPT Codes, ICD 9/10, and medical claim forms
• Excellent oral and written communication skills with exceptional attention to details
• Strong Organizational skills
• Proficient knowledge of the health insurance industry, medical and dental claims processing and customer service
• Strong knowledge of MS EXCEL & MS Word
• Adhere to deadlines
• Ability to read and understand contracts – Reinsurance contracts and Summary Plan Descriptions
• Work independently

Employee Benefits Program

COMPANY PROVIDES:

• MEDICAL, DENTAL, VISION
• SHORT-TERM DISABILITY
• Full coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.
• COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
• COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
• 401K Plan including company match up to 5%
• COMPANY PAID additional pension plan entirely funded by the company.
• EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
• Annual, automatic pay increases.

Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.