Supervisor Stop Loss

Required Qualifications

• Bachelor’s degree required
• El Dorado/Javelina experience, Health Rules Payer (HRP)

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Under the guidance of the Stop Loss Manager, The Stop Loss Supervisor will be responsible for overseeing and ensuring the completion for an end to end stop loss administration policy for Centivo’s self-funded clients. This includes but is not limited to specific claimant identification, completion of notification forms, reporting on high-cost claimants and clinical reports to the stop loss carrier, and claims filing to ensure Centivo meets its contractual and administrative responsibilities.

The Stop Loss Supervisor will work with various internal departments (including Client Success, Implementation, Claims, Member Care, IT, Clinical and Sales) and external PBMs. The Stop Loss Supervisor will also be the main point of contact for first level review of any issues, reporting concerns, as well working with other TPA’s in the industry, brokers, consultants, and various vendors to assist obtaining the necessary information for the stop loss management team to provide accurate policy management to Centivo’s clients.

• Responsible for overseeing the stop loss management team as it completes the end-to-end stop loss claim processes and procedures, ensuring all carrier requests are filed accurately and reimbursed timely on behalf of our clients.
• Own user acceptance testing for stop loss system upgrades and enhancements, ensuring existing functionality is preserved and new capabilities meet operational requirements.
• Work cross functionally with Stop Loss Coordinators, and all key stakeholders to ensure information and timely decisions are being made for the benefit of our client and organization.
• Work with the Stop Loss Manager to adjust processes, identify and source tools, manage staffing needs (new positions and training), and collaborate with internal teams as necessary for items requiring escalation.
• Maintain a process for identifying potential specific claimants within each client’s utilization data including collaboration with other key departments and monitor specific claimants in a timely fashion.
• Manage specific and aggregate claim submission processes, acting as liaison between Centivo and its stop loss carrier partners:
  • Ensuring new carriers have Non-Disclosure Agreements in place before sharing any client data
  • Providing stop loss carrier with necessary information required for claim reimbursement consideration and appeal submissions.
  • Requesting changes to stop-loss policy and/or client SPD as needed to ensure seamless coverage
  • Participating in internal work groups and task force(s) as needed to successfully implement stop loss administration
• Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement.
• Participate actively in team and department meetings on stop loss administration process and client/product implementation planning as it may relate to stop loss management.
• Ensure stop loss industry knowledge is current, bringing forward ideas and recommendations to ensure Centivo has a competitive position in the marketplace.
• Training new hires and teaching the necessary workflows and processes established, and creating and maintaining documentation outlining current state policies and procedures.
• Performs other miscellaneous projects, assignments, and duties as assigned by management.

• Monitoring and managing the team’s assignments, including resource balancing. (Please note this is a working supervisor position where the candidate will work hand-in-hand with their team members to complete the required work.)
• Developing policies, processes and procedures to further improve the department’s services.
• Defining staffing ratios and further define roles and responsibilities with the department.
• Lead the management of any new functionality and workflows to improve efficiency and automate…