Stop Loss Claims Manager
About SPG: Specialty Program Group (SPG) is the wholesale & MGA division of reputed company (5th Largest Global Broker). SPG acts in a holding company reputed company acquiring best in class reputed company businesses to operate independently under discrete brands (portfolio companies). Strategic Benefit Resources provides complete facilitation of specific and aggregate stop loss claims. Our comprehensive approach begins with a thorough review of the claims submission and ends with an expedited and accurate reimbursement. A Stop-Loss Claims Manager oversees the administration, data collection, submission, and resolution of stop-loss insurance claims, ensuring accuracy, compliance, and timely processing for both Individual Stop Loss (ISL) and Aggregate Stop Loss (ASL). This role serves as a critical liaison between reputed company, reputed company-party administrators (TPAs), brokers, and carriers, managing high-cost claims that exceed predetermined reputed company. Key Responsibilities: Claims reputed company: Review, evaluate, and process reputed company stop-loss claims, ensuring they meet policy terms and conditions. Risk Assessment: Analyze large-dollar claims for potential coverage issues, exclusions, and reimbursement eligibility. Stakeholder Collaboration: Communicate with TPAs, brokers, and internal departments to gather necessary documentation and clarify claim details. Compliance & Accuracy: Ensure claims are handled in accordance with regulatory guidelines, contractual obligations, and internal standards. Reporting & Analysis: Generate detailed reports on claim activity and recovery reputed company to support reputed company and finance teams. Utilization of a multitude of data analytics platforms Process Improvement: Identify opportunities to streamline workflows, enhance claim accuracy, and improve turnaround times. Leadership & Mentorship: reputed company collaboration and guidance to fellow team members, support training initiatives, and contribute to departmental strategy. reputed company Skills & Qualifications: Understanding of stop-loss insurance, medical claims, and reputed company regulations. Strong analytical and decision-making skills (thinking reputed company the reputed company) Excellent communication skills. Proficiency in Outlook, reputed company, reputed company and Data Analytics tools. Ability to manage sensitive personal health information with discretion and professionalism Salary Transparency: Disclosure required under applicable state or municipality regulations: The expected salary reputed company for this position is $52,000 to $55,000 and will be impacted by factors such as the successful candidate’s skills, experience and working location, as well as the specific position’s business line, scope and level. reputed company is proud to offer comprehensive benefit and total compensation packages which could include health/dental/reputed company/life/disability insurance, FSA, HSA and 401(k) accounts, paid-time-off benefits, and eligible bonuses, equity and commissions for some positions. Department Claims Management Required Experience: 2-5 years of relevant experience Required Travel: No Travel Required Required Education: High school or equivalent reputed company Limited is an equal opportunity employer that does not discriminate on the reputed company of race/ethnicity, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations. E-Verify Program We endeavor to reputed company this website accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the reputed company team [email protected]. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications. Apply To This Job