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Lead Stop Loss Representative
Job in
Philadelphia, Philadelphia County, Pennsylvania, 19107, USA
Listed on 2026-03-04
Listing for:
Blue Cross and Blue Shield Association
Full Time
position Listed on 2026-03-04
Job specializations:
-
Management
Healthcare Management
Job Description & How to Apply Below
Analyze monthly stop-loss reports and claims paid to identify data variances.
Investigate variances and identify the root cause.
Manage escalated inquiries to resolution.
Manage all production/issue tickets to initiate investigations into operational issues.
Perform weekly/monthly reconciliations.
Manager Index portal user access for new and existing updates as needed.
Manage external pbm data files. Point contact person to manage and address open issues to resolution.
Manage stop loss contracts. Add new/renewal contracts to the stop loss system.
Collaborate closely with the technical team to assist and answer questions as it relates to stop loss.
Manage a book of business as it relates to stop loss processing.
Participate on cross-functional project teams to as it relates to stop loss.
Identify processing gaps and work with appropriate departments to resolve.
Work with knowledge management to develop and maintain department procedures.
Work across teams to provide stop loss guidance as needed.
Assist team members with open inventory items as needed.
Train team on new and refreshed/updated processes.
Operate as back up to existing team lead as needed.
Perform additional tasks as needed.
8+ years of stop loss or claims experience
Critical thinking skills
Experience working in an operations environment.
Foster healthy working relationships within the team and across the business
Professional written and verbal communication skills
Strong thoroughness and organizational skills
Time management skills
Training experience is a plus
Workload Management skills
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
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