Stop Loss Administrator, LifeWise

at  Premera Blue Cross

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As a Stop Loss Administrator for LifeWise Assurance Company (LWAC), you will monitor and ensure compliance with Federal and Insurance Department regulations in the states where LifeWise Assurance Company is licensed. You will be responsible for interpreting and preparing documentation for the timely filing of Insurance Department reporting, preparing, and filing all contract forms and rates for LifeWise stop loss contracts in accordance with state and federal requirements, and creating and issuing stop loss contracts to LifeWise Assurance Company clients. This position will be responsible for financial reconciliations and reporting, as well as audits and ad hoc reporting. You will ensure the accuracy and timeliness of all levels of Stop Loss claims as well as interact with Actuaries, Reinsurers, and internal and external Third-Party Administrators.
This is a virtual/telecommuter position working from home. However, you will be expected to align with standard working hours (8:00 AM to 5:00 PM) in the Pacific time zone.

What you’ll do:

• Monitor regulatory requirements to ensure the timely update and maintenance of contractual language and documents in compliance with federal, state, and insurance department regulations, including HIPAA and ERISA.
• Develop processes and strategies to address customer specific product structures, configuration, and requirements. Work with legal, underwriting, and management to develop custom language as needed.
• Accurately set up new and renewing stop loss accounts and create and maintain contractual language and documents to distribute to Sales, Actuary, Finance, and Underwriting.
• Prepare and compile contract and rate documents. File contract forms, rates, and reports with the various insurance departments for each state based on each state’s requirements.
• Review state Insurance Department publications, regulations, and websites to identify changes that will have an impact on operations, filing requirements, or contractual language. Analyze proposed regulations, working with manager and legal to determine impact, and make recommendations for resolution.
• Track and analyze all stop loss claims for accuracy, researching claim detail and eligibility.
• Prepare timely claim reporting to Actuary and Management.
• Work with external third-party administrators and reinsurers to ensure proper reporting.
• Analyze monthly financial reporting including reconciling and confirming producer commission payments, claims, and reinsurance premium payments.
• Prepare and distribute producer reporting and disbursements as required by Management.
• Provide insurance regulation, contract, premium, commission, claims, and general stop loss expertise to Sales, Underwriting, and Actuary departments, responding timely to inquiries and requests.

What you’ll bring:

Required Qualifications

• Associates Degree in Business, Finance, or a related area, or (2) years of business experience.
• (6) years of work experience which provides understanding and working knowledge of:
• Basic medical stop loss insurance, basic contract law, with understanding of statutory and regulatory state insurance requirements
• Operational and accounting processes and functions
• Insurance claim processes and functions
• Previous experience developing and creating reports using Excel.
• Prior experience creating detailed management reports.

Preferred Qualifications

• In-depth knowledge of Medical Stop Loss functions including:
• Insurance accounting principles and practices
• Contract terms, rules, and laws
• Claims and reinsurance principles
• Knowledge of stop loss systems for product, accounting, and claim administration.
• Knowledge of Insurance Department regulations where LifeWise is licensed.
• Knowledge of System for Electronic Rate and Form Filing (SERFF).
• Extensive knowledge of Microsoft Excel, Word, and Adobe Acrobat Pro.

What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.
The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.
National Salary Range:
$67,800.00 - $98,400.00
National Plus Salary Range:

$67,800.00 - $112,200.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

• Monitor regulatory requirements to ensure the timely update and maintenance of contractual language and documents in compliance with federal, state, and insurance department regulations, including HIPAA and ERISA.
• Develop processes and strategies to address customer specific product structures, configuration, and requirements. Work with legal, underwriting, and management to develop custom language as needed.
• Accurately set up new and renewing stop loss accounts and create and maintain contractual language and documents to distribute to Sales, Actuary, Finance, and Underwriting.
• Prepare and compile contract and rate documents. File contract forms, rates, and reports with the various insurance departments for each state based on each state’s requirements.
• Review state Insurance Department publications, regulations, and websites to identify changes that will have an impact on operations, filing requirements, or contractual language. Analyze proposed regulations, working with manager and legal to determine impact, and make recommendations for resolution.
• Track and analyze all stop loss claims for accuracy, researching claim detail and eligibility.
• Prepare timely claim reporting to Actuary and Management.
• Work with external third-party administrators and reinsurers to ensure proper reporting.
• Analyze monthly financial reporting including reconciling and confirming producer commission payments, claims, and reinsurance premium payments.
• Prepare and distribute producer reporting and disbursements as required by Management.
• Provide insurance regulation, contract, premium, commission, claims, and general stop loss expertise to Sales, Underwriting, and Actuary departments, responding timely to inquiries and requests