Stop Loss Specialist

Role Description

Imagine360 is seeking a Stop Loss Specialist to join the team! This position coordinates the tracking, monitoring, documenting, and submission of stop loss claims. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Stop Loss Claims Management
  • Compiles and submits stop loss claims to the carrier for reimbursement.
  • Enters appropriate stop loss claims into designated database.
  • Identifies, researches, and resolves stop loss carrier questions.
  • Facilitates advancement funding with Finance Department.
  • Complies with reporting and documentation requirements.
  • Manages large case notifications process.
• Customer Service
  • Acts as a role model in demonstrating the core values in customer service delivery.
  • Provides timely and thorough follow up with internal and external customers.
  • Appropriately escalates difficult issues up the chain of command.
  • Trains new employees as assigned.
• Quality Assurance
  • Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving customer satisfaction.
  • Recognizes, documents, and alerts appropriate supervisor of trends.
  • Performs self-quality monitoring in order to develop and execute plans to meet established goals.
  • Provides ongoing feedback to help optimize quality performance.
  • Collaborates with others and cross-departmentally to improve or streamline procedures.
  • Develops new or improves current internal processes to improve quality.

Qualifications

• High School Diploma or GED
• 1+ years' experience in clerical and customer service
• Knowledge of medical terminology

Requirements

• Working knowledge of computers and software including but not limited to Microsoft Office products
• Proficient mathematical, 10-key and typing skills
• Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented
• Demonstrated ability to remain neutral and maintain confidentiality
• Strong written and oral communication skills
• Demonstrated ability to work independently, prioritize workloads, multi-task, and manage priorities in order to meet deadlines

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives