Job Description
Job Description
The Stop Loss Account Manager is responsible for responding to complex service inquiries, solving non-routine problems using independent judgment and discretion, and ensuring client satisfaction with the overall service experience.
Coordinates with Sales to ensure service needs are met and potential problems are averted. This role will require consultative thinking when decisions are needed in real time for brokers or clients.
These decisions or explanations may include how stop loss reimbursements were processed, the intricacies of specific products and enterprise data sharing policies.
Required :
- Bachelors degree or equivalent work experience. Five years or more of progressive responsibility with increasing levels of managerial expertise and responsibility in analysis of Stop Loss Insurance and Stop Loss claims administration.
- Must be thoroughly familiar with current health insurance market trends, services, contracts and pricing procedures.
- Ability to analyze and understand insurance contracts, terms, provisions, limitations and exclusions.
- Strong organizational skills.
- Self Motivator with the ability to motivate others.
- Established management of diverse operations and mentoring capability.
- Ability to work collaboratively with internal and external constituents to assure timely and reliable data outputs.
Desired :
- Advance capabilities with Microsoft Excel.
- Advanced Mathematical and statistical analysis skills.
- Advanced capabilities in manipulation data.
- Understanding of accounting principles and general ledger.
Responsibilities :
- Management of stop loss claims to ensure timely complete accurate claims administration.
- Responsibilities include managing intracompany relationships Claims, Reporting, Finance, Compliance and Account Management to assure customer focused administration of stop loss claims.
- Maintain favorable relationships with Stop Loss Carriers, Brokers and Account Management staff, UR / LCM vendors and PBMs.
Stay abreast of industry trends and developments.
- Mentor and develop Stop Loss Analyst staff and Reinsurance Specialist staff through knowledge transfer, exposure to carriers and markets.
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Five years or more of progressive responsibility with increasing levels of managerial expertise and responsibility in analysis of Stop Loss Insurance and Stop Loss claims administration. The Stop Loss Account Manager is responsible for responding to complex service inquiries, solving non-routine pro...
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