Excess Loss Analyst

Overview The Excess Loss Analyst manages Stop Loss insurance contracts for our clients. Key responsibilities include tracking monthly reports, submitting required claims documentation, coordinating funding requests, and preparing reports to help with contract renewals. Key Responsibilities Monitor claims: Review weekly claims activity to identify those eligible for Stop Loss reimbursement based on specific client contracts, using company-provided tools. Manage contract data: Stay current on changes to Stop Loss contracts and update internal tracking systems to ensure accurate reporting. Submit documentation: File timely notices and claims submissions when eligible cases arise, including coordinating with the Medical Management team. Track finances: Monitor claim submissions and receipt of Stop Loss funds. Reporting: Prepare and distribute monthly reports and renewal documentation to Stop Loss carriers. Coordinate funding: Work with the Claims Department to request advance funding and release claims once payments are received. External collaboration: Partner with outside vendors for subrogation and COBRA-related tasks. Internal advocacy: Serve as an internal point of contact for Stop Loss questions or issues, collaborating with other departments as needed. Tool enhancements: Work with the team to identify improvements for our internal analytical tools. Qualifications – Core Requirements Experience: 3–5 years of claims handling or related TPA experience. Technical aptitude: Ability to learn reinsurance practices, interpret complex Stop‑Loss contracts, and understand internal claims processing and Medical Management activities. Data security: Ability to securely handle Protected Health Information (PHI) and manage encrypted electronic file transfers. Soft skills: Strong analytical problem‑solving skills, excellent written/verbal communication, and the ability to work both independently and collaboratively within a team. Software: Proficiency with Microsoft Office and/or Google Workspace products. Preferred Qualifications (Nice-to-Haves) Education: Bachelor’s degree preferred. Background: Proven organizational and research skills with a strong attention to detail; a background in mathematics or auditing is highly preferred. Industry knowledge: Familiarity with medical terminology and standard coding formats (including CPT and ICD‑9/ICD‑10). Physical Requirements Ability to sit for long periods of time. Ability to see and hear within normal ranges, with or without aids. Ability to speak clearly. Hand and finger dexterity within normal ranges. Access to PHI Routine & re‑occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI. Benefits Health & Insurance: Medical (HSA and PPO plans) and Vision coverage, Dental plan, employer‑provided Life Insurance, and Short‑ & Long‑Term Disability coverage. Financial & Retirement: Health Savings Account (HSA) with company contributions, Flexible Spending Account (FSA), 401(k) plan with an employer match, and discretionary Profit Sharing. Time Off & Development: Paid Time Off (PTO) accrued based on tenure, Paid Holidays (including floating holidays and time for community service), and Tuition Reimbursement for continuing education. Support: Employee Assistance Program (EAP) for confidential professional counseling, and a Wellness program with rewards. Note: Benefits are subject to change with or without notice. #J-18808-Ljbffr First Choice Health