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.

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 ensure timely reporting and stop loss claim filing with various carriers on specific and aggregate stop loss filings.

Responsibilities Include:

• Monitor members approaching/exceeding spec, including policies with advance funding

• Monitor clients approaching/exceeding aggregate, including policies with accommodation

• Generate various reporting and reviews for accuracy before distribution, both internally and externally, as assigned.

• Gather supporting documentation from both internal and external entities.

• Compile stop loss claim filings, to include all supporting information/documentation, and submit to the stop loss carrier to maximize reimbursement

• Manage filings, through reimbursement, to include consideration of policy filing limitations

• Communicate regularly with various departments, external vendors, clients, and carriers.

• Validate filing denials and appeals when necessary, to ensure our clients are receiving the maximum reimbursement allowed under the policy

• Process an average of 4 to 5 claims per day, maintaining a processing accuracy of 99% or better

• Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim

• Elevate issues to the next level of supervision, as appropriate

• Other duties as assigned

Qualifications:

Required Skills and Abilities:         

• 4 years of stop loss claims experience

• Prior experience handling first dollar payer insurance (medical healthcare claims)

• Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing

• Associates degree required; Bachelor’s degree preferred

• Detail oriented with a high degree of accuracy and ability to multitask

• Ability to accept changing priorities with a minimum of disruption

• Strong problem solving, decision-making, reporting and analytical skills

• Must possess good judgment and work effectively with internal business areas, peers and co-workers

• Ability to work independently, prioritize, organize and assign your own work to meet deadlines

• Demonstrated proficiency in Microsoft Excel

Preferred Qualifications:

• El Dorado/Javelina experience

• Ringmaster Smart-LinQ Experience

Work Location:

This position is remote

Centivo Values:

• Empathy - We treat your problem as if it is our problem. Because it is. We are always glad to help because we care.

• Resourcefulness - If it needs to be done, we’ll figure it out and get it done, or make sure it gets done.

• Integrity - We do the right thing. Always. That includes placing people before profits.

• Possibility - We start with Yes.

• Reliability - We will always do what we say we will. You can count on us. Every single time.

• Teamwork & Collaboration – We treat each other with respect and listen, support and value each other’s opinions as we work toward our shared goals.

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.