Stoploss Coordinator

Description

SUMMARY: The Stoploss Coordinator is responsible for monitoring and preparing stop-loss data and reports for use by carriers and internal management.

• Claims perspective
• Deals with clients that hits the 50% stop loss or has Trigger Diagnosis
• Main contact in dealing with carriers, including Claims Analyst and nurses
• Works with all BRMS Departments including Claims, UR, Client Managers, Accounting, Customer Support, and COBRA
• Works with UR department to get more information on claims/prognosis and any underlying information to check with physician on additional information
• Works with UR department once notified of any upcoming diagnosis, notify carrier of pending concerns
• Works with Client Managers for initial enrollment forms, additional information, etc.
• Receives reinsurance checks; works with accounting to release money
• Works with COBRA on premiums payment, and eligibility
• Enters information in the system regarding status and follow up on public spreadsheet
• Sales and renewals to update issues
• Complies with policy period to file claims in timely fashion
• Runs weekly claims reports after the check run to research clients for 50% stop-loss or trigger diagnosis.
• Requests, hospital bills, police reports, as necessary for the claims filings
• Run prescription reports for claim filings
• Acts as another layer of claims auditing as part of the filing process
• Responsible for monthly reinsurance reports for accounting.
• Performs other duties and responsibilities as assigned by Management.

This job has no supervisory responsibilities.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

• Excellent written and verbal communication skills.
• Strong analytical skills and problem-solving skills.
• Must be dependable and maintain excellent attendance.
• Subject-matter expert within field.
• Must be able to perform data entry operations quickly and accurately.
• Ability to grow with changing demands of the position and the company.
• Strong computer skills, including Word, Excel, Outlook, and Claims System organization.
• Must be highly proficient in ICD-9, CPT, UBO4, HCFA codes.
• Must be highly organized and detail oriented.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Associate's degree (A.

A.) or equivalent from two-year college or technical school; two years working claims knowledge and/or training; or equivalent combination of education and experience.

Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations.