You are detail-oriented, results-oriented and enjoy delivering high quality, on-time solutions for your stakeholders. You have a minimum of 5 years of experience administering Stop Loss policies for self-funded employers. Individuals who will be successful in this role are motivated to understand complex Stop Loss arrangements and possess the requisite industry knowledge to resolve all Stop Loss challenges.

What You’ll Do

• Review Stop Loss contracts and provide detailed business requirements to configuration team
• Examine plan documents to ensure that claims are processed in accordance with employer and Stop Loss expectations
• Ensure proper cost containment techniques have been employed in support of loss ratio targets
• Coordinate all Stop Loss services along with large dollar claims to achieve ongoing employer satisfaction
• Build and maintain all necessary Stop Loss reporting including notification reports, funding requests, and monthly aggregate reporting
• Develop implementation plans and manage the implementation of new or changed Stop Loss processes
• Follow relevant Stop Loss and self-funded insurance regulatory developments and determine how core operational processes and workflows need to be modified
• Ensure operational processes are analyzed for continuous process improvement
• Define performance metrics as necessary to measure the impacts (positive or negative) of current and new business processes
• Establish and maintain positive working relationships with internal and external stakeholders

Preferred Experience

• Minimum of 5 years of experience supporting self-funded employer administration along with experience managing Stop Loss teams
• Broad knowledge of self-funded health insurance payer practices
• Knowledge of regulations that apply to self-funded clients
• Knowledge of all industry Stop Loss processes and procedures
• Experience communicating and influencing effectively at all levels and with vendors
• Solid mathematical aptitude with ability to quantify impact and ROI of initiatives
• Strong technical skills, business intelligence, and a full understanding of the needs of customers