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Amherst. Aither Health. Stop Loss Analyst. $25 - $30/hour.

Job Summary: This position is responsible for operational support functions to include Stop Loss related client annual reporting, analytical reporting, benefit analysis, and various internal reports in accordance with each Clients specific Stop Loss policy.

Essential Functions: Percent of time

COMMUNICATION/COLLABORATION: 50% * Clearly communicate both written and verbally with confidence to internal and external customers. * Work collaboratively with cross functional teams. * Demonstrate, manage and maintain Stop Loss relationships with multiple carriers. * Ensure carrier procedural requirements are updated. * Responsible for all tasks relating to stop loss for customers, both internally and externally to include coordination of interdepartmental process when necessary (e.g. advance funding processes, special claim handling, check runs, check pulls, policy end). * Follow-up as needed on stop loss filings and communicate with the client, broker and/or stop loss carrier as necessary.

ADMINISTRATIVE: 45% * Prepare and submit claims for advance funding and/or reimbursement to the stop loss carrier with significant attention to detail and accuracy. * Research individual claim disputes and provide resolution. * Responsible for internal and external customer satisfaction in the resolution of claims.
* Maintain record of reimbursement check and coordinate the routing of reimbursements back to the client if applicable.
* Develop and prepare reports for the client and/or stop loss carrier. These include aggregate Stop Loss reports, specific (50%) stop loss reports and High Cost Claimant reports. * Facilitate the request of ad hoc reports. * Manage the monthly stop loss ending process to include notification to appropriate interdepartmental teams, clients and/or brokers. * Monitor and track total reimbursement dollars for clients and prepare reporting for internal and external customers. * Track reimbursement claims and support finance for accurate payment reconciliation.

Other duties as requested by supervisor: 5%

REQUIREMENTS:

Education: Associate Degree required or two (2) years experience in the self-funded health insurance industry may be considered in lieu of degree.

• The ability to meet performance goals, including accuracy and productivity. Strong attention to detail and accuracy.
• Working knowledge of medical and dental benefit designs and interpretations.
• Excellent written, verbal, and interpersonal communication skills.
• 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.
• Ability to demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated.
• Strong computer knowledge.
• Excellent administrative skills
• Proficient in Microsoft office proficient (word/excel)
• Proven ability to multi task

Preferred: * Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services required, self-funded healthcare experience.

To apply, forward cover letter and resume to: https://aitherhealth.com/careers/join/