POSITION SUMMARY:

This position is responsible for: (1) tracking and auditing stop loss claim submissions to ensure they are accurate and done in a timely manner. (2) ensure standard monthly stop loss reporting is accurate and provided in a timely manner. and (3) be an advocate for the stop loss processes and create transparency of any concerns to the various departments, such as the Account Executive, Claims and Medical Management team.
This position will be responsible for producing ad hoc reports and analysis to support the stop loss processes for internal and external needs as well as other non-stop loss related ad hoc,analysis and project work to support the overall objectives of the HCA team .
As a part of a small team in a dynamic company, this person is expected to be a self-starter who has demonstrated the ability to quickly and independently learn how to use software tools and healthcare data as required.. He/she should be comfortable working within a team and independently with internal customers, such as the Account Executive Team, to ensure stop loss requirements and ad hoc requests meet requirements.

QUALIFICATIONS:

• Associate Degree minimum, Bachelor’s degree preferred in an analytic field such as Finance, Economics, Mathematics, or other related field, or equivalent experience.
• Strong analytical problems solving skills. Proven analytical experience working with healthcare claims data; or equivalent knowledge of healthcare data, and proven technical aptitude to quickly learn software tools to support needed data & analysis.
• Diligence to details, preference for mathematics or auditing background
• Ability to learn & understanding general reinsurance practices, our clients’ stop loss contracts, our claims processing systems and related Medical Management activities
• Ability to work with PHI and send secured electronic transfer of files.
• Strong written, verbal, analytical, and interpersonal skills. Willingness to ask questions when assigned a task.
• Ability to work independently and in a team in an organized manner to meet deadlines.
• Ability to react quickly to needs and priorities of internal and external clients.
• Comfortable with software applications such as GSuite or Microsoft products such as SHEETS or Excel.
• General understanding of relational databases and programming for reporting purposes. Experience in the AWS platform is preferred.

PHYSICAL REQUIREMENTS:

• Ability to sit for long periods of time.
• Ability to see and hear within normal ranges, with or without aids.
• Ability to speak clearly.
• Hand and finger dexterity within normal ranges.

• Learn reinsurance practices, interpret our client’s stop loss contracts, FCH claims processing and related Medical Management activities
• Responsible for collecting and understanding stop loss contracts and maintaining related internal tables of these terms used for automation & reporting and developing solutions to unique contract terms or timeframes. E.g. applying non-FCHA claims
• Peer review the SL analyst’s submissions & standard monthly/renewal reporting
• Be an internal advocate for Stop Loss submission requirements and issues, working with other departments as needed.
• Work with HCA team members or other departments (e.g. BAT, Claims, IT) for any tool and process improvements
• Create transparency across departments on stop loss activity using Stop Loss committee or other means
• Develop ad-hoc reporting and analysis as required to support TPA clients/brokers.
• Audit and\or research data as it relates to healthcare analytics and our analytical vendors.
• Provide back-up and support to other team members.
• Other duties as assigned.