Health Claims Stop Loss Specialist

Overview

Now is the time to join us! 

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Who are you?

The Stop Loss Specialist is responsible for supporting the coordination and filing of Specs, Advance Funding, and Plan Year End Closeout’s.  The incumbent is expected to communicate professionally with peers, supervisors, subordinates, market, customers, and the public, and be respectful and courteous in the conduct of this position.

Production schedule: 8:00 a.m. to 5:00 p.m. CST

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Prepare Stop Loss claims and applicable documents to determine Stop Loss filing eligibility applicable to the Excess Loss Policy.
• Files submissions of spec claimants (running reports, gathering necessary documents and email correspondence), processing all submissions within established internal timeframes.
• Coordinate Advanced Funding Requests, with the client and the Stop Loss carrier.
• Maintains database of all specific reimbursement requests.
• Creates initial Specific File for each claimant, files all submissions in our EDOCS platform.
• Coordinates the release of Over Specific, System Hold “on hold” claims.
• Acts as the liaison between the PBM’s and internal clients, as it pertains to our Stop Loss claimants.
• Keeps immediate supervisor apprised of open or disputed items.
• Contributes to daily workflow with regular and punctual attendance.
• Performs related or other assigned duties as required or directed.
• Monitors all reinsurance requests to ensure receipt of reimbursement.
• Generates weekly outstanding reimbursement report and follows up with the Stop Loss carrier.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• High school diploma or general education degree (GED) required.
• Minimum three (3) year related experience and/or training; or equivalent combination of education and experience.
• Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses or seminars relative to Stop Loss and related topics preferred.
• Knowledge of medical terminology, CPT, HCPCS and ICD-10 codes
• Strong written and verbal communication skills
• A detail-oriented, analytical, financially minded approach
• Demonstrate ability to work independently with excellent judgment

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Excel and Outlook.
• Knowledge of insurance database system a plus.
• Ability to read, analyze, and interpret common financial reports and legal documents.
• Ability to organize, prioritize, and multitask in a fast-paced environment
• Ability to effectively present information to top management, public groups, and/or boards of directors.
• Ability to work with mathematical concepts such as probability and statistical inference.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Required Internet & Speed Standards for Remote Employees: Must maintain a reliable internet speed and meet the requirement of at least 10 Mbps upload speed and 20 Mbps download speed. Internet connection must be hardwired into modem/router (ethernet cable is provided). No MiFi or Wi-Fi connection is allowed when completing calls

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from 17.00 to $24.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.