Stop Loss Specialist
: Job Details :

TITLE: Stop Loss Specialist

LOCATION: Remote (PST/MST Required)

TYPE: Contract (6+ months with opportunity to convert)

PAY: $32 - $40/hr + DOE

BENEFITS: Medical insurance, 401K, sick leave, and employee assistance program. Depending on your package selection, Averro offers PTO, paid holidays, dental/vision, pet, and legal insurance.

ROLE & RESPONSIBILITIES

We are seeking a Stop Loss Specialist for a third-party healthcare administration company. This would be a great opportunity for someone with insurance experience that is looking to join a small company that offers a great culture!

As a Stop Loss Specialist, you will ensure that stop loss claim submissions are handled smoothly and as quickly as possible. You will file claim submissions to reinsurance carriers, update and track each submission and ensure the timely payment of claims.

• Act as a primary liaison between our company and the reinsurance carriers on complex claims payment issues
• Ensure relationships are developed and maintained while claims are funded correctly and as quickly as possible.
• Works closely with the Client Services team to ensure timely and meaningful communication with the client regarding existing or potential stop loss claims.
• Works closely with the Care Management team to identify potential stop loss claimants, and in the development of appropriate reporting for clients and stop loss carriers.
• Submit appropriate claims and forms to reinsurance carriers for reimbursement; including follow up as necessary.
• Coordinate new group set up with the reinsurance carriers, managing approval process, monitoring stop loss contract changes, and coordination of all stop loss carrier audits.

ESSENTIAL QUALIFICATIONS

• 3+ years of Stop Loss claims insurance experience, additional claims experience could supplement stop loss experience
• Associate or Bachelor's degree desired
• Proven track record or managing stop loss programs including underwriting, claims review, and contract negotiation.
• Experience working with self-funded health plans and understanding of healthcare claims.
• Exceptional communication skills, capable of working with clients, brokers, carriers, and internal teams

WHY AVERRO?

Averro is a Veteran-Owned organization dedicated to delivering innovative talent solutions, business consulting, and technology services that propel businesses and careers forward. We live by our ethos: Be Curious | Build Trust | Empower Each Other. These values show in our commitment to client satisfaction, timely support, and unmatched consultant care. Our Aim – Your Ascent.

Averro is an equal opportunity employer, and we are committed to diversity, equity, and inclusion in the workplace. All qualified applicants will receive consideration for employment, regardless of criminal histories, consistent with legal obligations. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

View our privacy policy here: