Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Position Summary

The position will report to the Stop Loss Manager of Consociate Health. The Stop Loss Coordinator will be responsible for all aspects of the stop loss process as it relates to client stop loss claims and reimbursement.

Principal Duties And Responsibilities

• Work closely with our stop loss carriers externally, as well as the Claims Department internally, to ensure all claims eligible for stop loss reimbursement are received, reported and processed timely. Provides updates to internal teams, vendors and clients as needed.
• Complete and file appropriate documentation to stop loss carriers for specific and aggregate claims. This includes but is not limited to 50% notifications, claim reimbursements, additional information as requested by the carrier, etc.
• File stop loss reimbursement claims for assigned clients according to the requirements of each stop loss contract.
• Monitor reimbursements from stop loss carrier. Work with general underwriters, carriers and clients to resolve any issues regarding stop loss reimbursement.
• Updates current spreadsheet of filed and outstanding reinsurance claims as well as denied claims.
• Creates, maintains, and distributes weekly and monthly reporting to the CFO, Claims Director and Client Relations Consultants (per assigned client).
• Perform other duties as assigned.
  
  

Benefits

• Paid time off
• Paid Holidays
• Medical, Dental and Vision Insurance
• Basic Group Life, Short Term and Long Term Disability
• Voluntary Life, Critical Illness and Accident Coverage
• 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.
  
  

Required Experience

General Expectations:

• Present a positive image of Consociate at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer, or co-worker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed. Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goals efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
  
  

Knowledge, Skills, And Ability Requirements

• High School Education required, come college preferred.
• Excellent written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Must be able to perform data entry operations quickly and accurately.
• Strong computer skills, including Word, Excel, Outlook, and Claims System organization.
• Basic understanding of accounting procedures.
• ICD-10 and CPT code experience preferred.
• Must be highly organized and detail oriented.
  
  

Keyword: Stop Loss Coordinator