Job Title

Stop Loss Submission Coordinator

Status: Non Exempt

This is a hybrid position - 3 days a week in Amherst NY

Why this role is important:

What you’ll do:

• Clearly communicate both written and verbally with confidence to internal and external customers.
• Work collaboratively with cross functional teams.
• Prepare and submit initial & subsequent claims to the stop loss carrier as requested.
• Maintain record of submissions.
• Follow-up as needed on stoploss filings and communicate with the client, broker and/or stop loss carrier as necessary.
• Research individual claim disputes and provide resolution.
• Responsible for internal and external customer satisfaction in the resolution of claims.
• Monitor and track total reimbursement dollars for clients and prepare reporting for internal and external customers.
• Track reimbursement of claims and provide support for accurate payment reconciliation.
• Ensure all claim payments are issued upon receipt of stoploss funding.

What you’ll bring:

• Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services; self-funded healthcare experience preferred.
• The ability to meet performance goals, including accuracy and productivity.
• Working knowledge of medical and dental benefit designs and interpretations.
• Able to express ideas clearly in writing and conversation.
• Knowledge of negotiation strategies related to healthcare claims.
• Effective organizational and time management skills. Must be able to work independently without supervision and have demonstrated experience in exercising appropriate decision-making.
• Initiative and self-motivation, with the ability to effectively solve problems as they arise.
• Ability to research individual claim disputes and provide resolution.
• Strong working knowledge of Microsoft Excel, including formulas and data organization.
• Ability to demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated.

Compensation Range:$21/hr - 30/hr

Physical Requirements: Prolonged period sitting at a desk and working on a computer and the ability to lift 15 pounds.

Actual starting pay within this range will be determined based on several factors, including relevant experience, healthcare or TPA industry knowledge, skills, and overall qualifications. Final compensation will also take into account internal equity and market factors.

As an Equal Opportunity / Affirmative Action Employer, Aither Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Aither Health will not tolerate discrimination or harassment based on any of these characteristics. Aither Health encourages applicants of all ages.