Stop Loss Analyst
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.
Summary of role:
As a Stop Loss Analyst, you will serve as a key leader with ownership of end-to-end stop loss policy administration for Centivo’s self-funded clients and working with various internal departments (including Client Success, Implementation, Claims Operations, Member Care and Sales). You will cultivate strategic relationships with Centivo’s stop loss carrier partners, working with account managers, TPAs, brokers, agents, and vendors to assist and complete the stop loss renewal process.
Responsibilities Include:
Working under guidance of our Stop Loss Manager, you will:
Maintain a process for identifying potential specific claimants within each client’s utilization data including collaboration with other key departments to identify 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 including:
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 workgroups and task force(s) as needed to successfully implement stop loss administration in claims system.
Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement.
Create and deliver monthly reports to carriers, including Aggregate Accommodations and Year-End Aggregate Filings.
Schedule and automate recurring reporting tasks to meet internal and carrier-specific goals.
Generate timely and accurate financial data for monthly report submissions.
Proactively reviews weekly reports to identify potential high-cost claimants.
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 competitive position in the marketplace.
Convey renewal information for stop-loss rates internally within Centivo.
Utilize developed understanding of all aspects of operational functions to efficiently perform to the established service standards as related to renewals and client service.
Elevate client issues and concerns to appropriate Manager, Client Services and/or Account Management.
Performs other miscellaneous projects, assignments, and duties as assigned by management.
Qualifications:
Required Skills and Abilities:
Advanced knowledge of Microsoft Office products (Excel, Power Point, Word)
Strong customer service, organizational and time management skills
Demonstrated ability to meet performance goals, including accuracy and productivity
Excellent written, verbal, and interpersonal communication skills
Ability to access, operate, and maintain various software applications
Ability to work independently with minimal supervision
Strong interpersonal skills, establishing rapport and working well with others
Education and Experience:
4 years of experience in stop loss, claims operations, financial analytics, customer service, or client services required
Associates degree required; Bachelor’s degree preferred
Stop Loss policy management and marketing experience required, specifically with self-funded insurance, level-funded based client knowledge
Knowledge of the claims/submission process
Preferred Qualifications:
El Dorado/Javelina experience, Health Rules Payer (HRP)
Ringmaster Smart-LinQ Experience
Centivo Values:
● Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.
● Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
● Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.