Stop Loss Coordinator I

    • Job Tracking ID: 512935-609151
    • Job Location: Meridian, ID
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: March 09, 2018
    • Years of Experience: Up to 2 Years
    • Starting Date: April 16, 2018
    • Salary Type:: Hourly
    • Rate:: 12.14
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Job Description:

Job Summary


Serves as the primary source for communication with clients and stop loss vendors. Responsible for ensuring all stop loss claims are filed timely with stop loss carriers. Follow-up with stop loss carriers if claims are not reimbursed timely and appealing denied claims. Coordinate the processing of stop loss claims internally with departments in regards to policies and procedures to line up with stop loss carrier expectations.


Key Result Areas


  • Maintain and track reports on specific claims/clients with stop loss carrier

  • Manage Excel reports by client looking for potential stop loss impact

  • Monitor stop loss, compliance, medical management, and other departments in areas relating to stop loss policies and procedures in areas impacting claim determination, large claim notifications, and renewals

  • Monitor 50% filings and potential large claim notifications

  • Assist department in coordinating end of policy year claims to ensure claims are paid within the stop loss contracts

  • Update and maintain all stop loss claim policy and procedures

  • Performs other related duties as assigned or needed by Stop Loss Team Lead


Experience and Skills:


Minimum Qualifications


  • High school graduate or equivalent

  • Ability to work efficiently, be organized, multi-task, prioritize and meet tight deadlines

  • Good problem solving and analytical skills

  • Excellent verbal and written communication skills

  • Proficient knowledge of Microsoft Office with an emphasis on Excel

  • Knowledge of GBAS and report manager

  • Stop loss knowledge preferred but not required

  • Ability to efficiently and effectively perform the Essential Key Result Areas

  • Protect and enhance the Core Purpose and the Core Values of the AmeriBen/IEC Group