Stop Loss Claims Specialist

Stop Loss Claims Analyst

Marsh McLennan Agency's East Region is a leader in the employee benefits marketplace. Our associates simplify employee health and welfare benefits and risk management for regional, national, Fortune 500 and Fortune 1000 companies.

We value integrity, collaboration, passion, innovation, and accountability, and we are committed to making a difference in the moments that matter for our colleagues, clients, and communities.

The primary role of the Stop Loss Claims Analyst role is to manage the stop loss claims process for the MMA Stop Loss Center of Excellence including establishing the claims submission process in accordance with vendor processes, overall tracking and auditing to assure timely payment of eligible stop loss claims managed by the Center of Excellence.

Essential duties and responsibilities include, but are not limited, to the following:

• Partner with carriers and internal teams to establish as a preferred method automated file feeds with common identifiers when possible. In situations where automated file feed exchanges are not possible work to confirm viability/alignment of each parties internal processes to assure required claims data can be shared at the agreed upon intervals and methods.
• Collaborate with internal MMA Agency contacts to have the MMA Stop Loss Center of Excellence provided with the appropriate ongoing reporting or TPA/PBM system access to obtain reporting needed to support overall process.
• Work with Trion Compliance and MMA Legal to execute any required Non-Disclosure Agreement, Confidentiality Agreement or related required Authorization that may be needed to either receive or have access to a portal containing claims data.
• Perform analysis using established process/and or systems to combine data files from various vendors to determine overall total risk exposure to develop reporting to be delivered to the applicable MMA Agency for delivery or inclusion in their overall financial reporting process on a monthly basis.
• Leverage the total risk exposure to assure stop loss vendor alignment on projected eligible and final paid claims to assure accurate and timely payment of eligible claims.
• Work through any identified discrepancies including escalation of claims issue as appropriate.
• Work with local MMA Agency team to assure any required documentation including eligibility, leave policies, required subrogation forms or alike are requested from the Client and provided back to the stop loss vendor to assure timely payment of eligible claims.
• Send out reminder requests to all applicable TPAs to submit all eligible claims prior to the end of a plan or policy year in an effort to maximize all eligible stop loss reimbursements.
• As requested by the Employer in coordination with the local MMA Agency team request as appropriate any interim bills.
• Update management team on identified trends in stop loss market claims adjudication process and execution to be addressed as part of ongoing panel management conversations;
• As capacity allows at the direction of the Director of the Stop Loss Center of Excellence provide claims coordination support for identified Trion accounts.
• Maintain quality service standards and organization to assure timely service to Trion and MMA Agency teams;

• Remain abreast of the dynamic, competitive insurance environment, new and complex insurance initiatives, appropriate data analysis techniques and constantly changing legislation that governs business;
• Support other initiatives of the Strategic Initiatives Division and Underwriting Team as needed.

Required education and experience:

• Minimal of High School Graduate with Associate's Degree in Risk Management & Insurance, Actuarial Science, Mathematics and/or other related field is preferred or equivalent experience preferred;
• Minimum of two years prior work experience the Benefits Brokerage, Consulting, or Insurance industry;
• Strong background in self-funding, stop loss or claims administration required.

Knowledge, skills and abilities:

• Strong organizational, analytical skills and strong attention to detail;
• Excellent troubleshooting, decision making and problem solving skills;
• Proven ability to support multiple projects simultaneously with attention to detail and process;
• Ability to multi-task and work in a fast-paced environment;
• Excellent verbal and written communication skills;
• Ability to prioritize projects and meet deadlines;
• Ability to follow through on and successfully execute tasks while adhering to specified quality standards;
• Must be able to effectively interact with people internal and external customers
• Intermediate knowledge of MS Office Suite (Word, Excel, Access, Outlook), working knowledge of pivot tables.

Physical demands and work environment:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is:
• Frequently required to sit; speak or hear; use hands to finger, handle, feel objects, and reach with hands and arms;
• Occasionally required to stand and walk;
• Extensive use of computer and keyboard and viewing of computer screen is required;
• Specific vision abilities required by this job include vision, and ability to adjust focus.
• Other working conditions are normal for an office environment.

Work location:

• Work is typically performed either on site at MMA East's Conshohocken office, or at various customer/MMA locations as required.
• This position is not available for remote work from Colorado.

The applicable base salary range for this role is $57,738 to $65,000.

The base pay offered will be determined on factors such as experience, skills, training, location, certifications, and education. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives.

We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.

Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age background, disability, ethnic origin, gender orientation or expression, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, veteran status (including protected veterans), or any other characteristic protected by applicable law. If you have a need that requires accommodation, please let us know by contacting View email address on click.appcast.io