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

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

Company: Cobalt Benefits Group LLC


Job description: Description:Stop Loss Claims Analyst/Risk Management SpecialistFull-timeReports to Director of Stop LossOnsite/HybridIn 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 veteransPI3e65a90b63dc-8722-35889578

Expected salary:

Location: Burlington, VT

Job date: Sun, 27 Oct 2024 07:53:10 GMT

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