Stop Loss Claims Analyst/Risk Management Specialist for TPA Healthcare Benefits

Full-time

Reports to Director of Stop Loss

Onsite/Hybrid

In this dynamic role, you will oversee the stop-loss insurance process, manage claims, coordinate with vendors, and ensure compliance with industry regulations. Your analytical mindset and industry knowledge will directly contribute to our clients' success and satisfaction.

Key Responsibilities

Claims Management: Analyze and process stop-loss claims to ensure accurate and timely reimbursements for eligible claims exceeding specific deductibles.• Vendor Liaison: Serve as the main point of contact with excess loss vendors, facilitating data submissions and resolving inquiries efficiently.

Data Analysis: Monitor claims data to identify trends and opportunities for enhancing the stop-loss program, ensuring our clients receive optimal support.

Reporting: Generate comprehensive monthly and year-end aggregate claims reports for internal stakeholders and external vendors.

Policy Compliance: Maintain adherence to regulatory requirements and best practices in all processes and documentation.

Client Engagement: Communicate proactively with clients regarding their stop-loss coverage and claims status, providing exceptional service and support.

Training and Development: Educate and support internal teams on stop-loss processes and industry best practices.

Requirements:

What We're Looking For

Education: Bachelor's degree in finance, business administration, healthcare management, or related field preferred.

Experience: At least 3 years in healthcare claims management or stop-loss insurance, with a proven track record of success.

Industry Insight: Strong understanding of stop-loss insurance policies and healthcare claims processing, with familiarity in medical terminology.

Analytical Skills: Exceptional analytical abilities, adept in data analysis and reporting tools.

Detail-Oriented: Precision and accuracy are paramount in managing claims and documentation.

Strong Communicator: Excellent verbal and written communication skills to engage effectively with clients, vendors, and colleagues.

Organizational Skills: Ability to manage multiple projects in a fast-paced environment, meeting deadlines with ease.

Why Join Us?

At Cobalt Benefits Group we offer more than just a job; we provide a pathway for your professional growth and development. Our comprehensive benefits package includes:

• Competitive medical, dental, and vision insurance.

• Company-paid Basic Life and AD&D insurance.

• Flexible Spending Accounts.

• 401(k) Retirement Plan with employer match.

• Generous paid time off and holidays.

• A culture of innovation, collaboration, and professional development

Equal Opportunity Employer, including disability/protected veterans

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