Under the guidance of the Vice President of Sales Operations, you will work with various internal departments (including Client Success, Implementation, Claims Operations, Member Services and Sales). You will also be the main point of contact for first level review of any issues, reporting concerns, as well working with other TPA’s in the industry, brokers, consultants, and various vendors to assist obtaining the necessary information for the stop loss management team to provide accurate policy management to Centivo’s clients.
The Stop Loss Manager will be responsible to oversee and ensure the completion for end to end stop loss policy administration for Centivo’s self-funded clients. This includes but is not limited to specific claimant identification, completion of notification forms, reporting on high-cost claimants and clinical reports to the stop loss carrier, and claims filing to ensure Centivo meets its contractual and fiduciary responsibilities.
- Monitoring and managing the team’s assignments, including resource balancing. (Please note this is a working manager position where the candidate will work hand-in-hand with their team members to complete the volume of work.)
- Developing policies, processes and procedures to further improve the department’s services
- Defining staffing ratios and further define roles and responsibilities with the department
- Lead the development\management of any new functionality and workflows to improve and automate current manual processes
- Ensure knowledge transfer and training is delivered, retained and reinforced
- Be responsible for overseeing the stop loss management team completes the end-to-end stop loss claim processes and procedures are completed timely for all stop loss reporting and policy advance funding/reimbursements are completed filed and reimbursed timely.
- Ensure the business requirements for the configuration and management of Centivo’s stop loss administration software system and be responsible for the successful implementation and execution of those requirements.
- Work cross functionally with Stop Loss Coordinator, finance, claims and product teams to ensure information and timely decisions are being made for the benefit of our client and organization.
- Work with the Vice President of Sales Operations to adjusting processes, identifying and sourcing tools, identifying staffing needs (new positions and training staff), and collaborating with internal teams to as necessary for items requiring escalation.
- Maintain a process for identifying potential specific claimants within each client’s utilization data including collaboration with other key departments to identify and monitor specific claimants in a timely fashion
- Manage specific and aggregate claim submission processes, acting as liaison between Centivo and its stop loss carrier partners including:
- Ensuring new carriers have Non-Disclosure Agreements in place before sharing any client data
- Providing stop loss carrier with necessary information required for claim reimbursement consideration and appeal submissions.
- Requesting changes to stop-loss policy and/or client SPD as needed to ensure seamless coverage
- Participating in internal workgroups and task force(s) as needed to successfully implement stop loss administration in claims system
- Collaborate with Sales Executives, Account Managers and/or other internal department(s) for the management of renewal quote requests
- Complete all renewal paperwork including stop-loss proposal, stop loss application, and stop loss contract, then submit/save items to appropriate parties/locations
- Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement.
- Generate timely and accurate financial data for monthly report submissions
- Proactively reviews weekly reports to identify potential high-cost claimants
- Participate actively in team and department meetings on stop loss administration process, client/product implementation planning as it may relate to stop loss management
- Ensure stop loss industry knowledge is current, bringing forward ideas and recommendations to ensure Centivo has competitive position in the marketplace
- Training new hires and teaching the necessary workflows and processes established, and creating and maintaining document outlining current state procedures
- Attend meetings and collaborate with other departments as needed for representation of the Stop Loss team
- Convey renewal information for stop-loss rates internally within Centivo
- Utilize developed understanding of all aspects of operational functions to efficiently perform to the established service standards as related to renewals and client service
- Elevate client issues and concerns to appropriate Manager, Client Services and/or Account Management
- Performs other miscellaneous projects, assignments, and duties as assigned by management
Required Knowledge, Skills and Abilities:
- Strong leadership and team management skills
- Demonstrated abilities with process development and improvement as well as change management
- Excellent oral and written communications; an ability to present information in a way that establishes rapport, persuades others, gains understanding.
- Ability to anticipate the oncoming workload, identify barriers, and ensure all required work is completed timely
- Advanced knowledge of Microsoft Office products (Excel, Power Point, Word)
- Strong customer service, organizational and time management skills
- Demonstrated ability to meet performance goals, including accuracy and productivity
- Ability to access, operate, and maintain various software applications
- Ability to work independently with minimal supervision
- Demonstrated commitment to Centivo’s mission and values
Education and Experience:
- 10 years of experience in stop loss policy management and/or financial claims analytics required
- Bachelor’s degree required
- Licensed, Life Accident and Health Insurance required
- Stop Loss policy management and marketing experience required, specifically with self-funded insurance
- Knowledge of the stop loss claims/submission and stop loss carrier reporting needs
- El Dorado/Javelina experience
- Ringmaster experience
- This position is remote and or in the Buffalo Office