Teams at Point C

Processes and adjudicates medical claims, adjustments, appeals, subrogation cases, and claim payments. Ensures compliance with plan documents, stop-loss terms, policies, and regulations while meeting accuracy and productivity targets. Responds to inquiries, follows up on missing information, and maintains timely claim turnaround. Requires insurance claims processing experience, knowledge of benefit plan design, CPT and ICD-10 coding, medical terminology, and claims administration systems.

Coordinates end-to-end stop-loss claims filing, including preparing documentation, verifying eligibility, maintaining claim records, communicating with clients and carriers, reviewing policy documents, managing funding requests, and generating financial reports. The role also supports renewals, audits, compliance, process improvement, and internal tracking activities while serving as a liaison among stakeholders.

Leads client management, retention, revenue growth, and service delivery for an assigned third-party administrator business region. Manages account management teams, workforce planning, customer relationships, strategic initiatives, operational alignment, issue resolution, and performance reporting. Partners with sales on broker engagement, finalist presentations, and business development. Provides consultative account leadership while ensuring client satisfaction, profitability, and consistent delivery of the company’s service model.