Benefits Consultant -
Location: Minneapolis
Posted on: October 29, 2024
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Job Description:
Summary/Mission
Achieve superior Stop Loss performance through an integrated
process of operational, cost and resource management meeting and/or
exceeding plan sponsor and member expectations.
Position Summary/Mission
Acts as a liaison and subject matter expert between our internal
and external clients and the stop loss administrators. Reviews and
manages stop loss claim filings. Resolves discrepancies between the
amount requested and the amount reimbursed by the stop loss
carrier.
Fundamental Components and Physical Requirements include but are
not limited to (*denotes essential function)
? Acts as principal point of contact for stop loss administrators
(*)
? Review and investigate inquiries from stop loss administrators
(*)
? Manage and/or request retro pre-cert reviews, medical necessity
inquiries, medical records & physician orders, etc.(*)
? Utilize all applicable system functions and department
relationships to finalize stop loss filings (*)
? Perform manual processes related to mid-year takeovers, plan year
end, special handling clients, stop loss policy reviews,
etc.(*)
? Review Actively at Work (AAW) eligibility documents prior to
submission to stop loss administrator (*)
? Review and resolve mismatched filings prior to submission to stop
loss administrator (retention review, aggregating-specific review,
etc.) (*)
? Review, adjudicate and appeal as necessary mismatched stop loss
reimbursements (*)
? May process filings on other claim platforms (e.g. Eldorado,
LuminX)
? Maintaining good relationships with internal and external
clients
? Escalate complex issues to Stop Loss Senior Analyst or Stop Loss
Management as directed(*)
? Use system reporting tools to maintain and manage daily work flow
(*)
? May perform processes (In/Out Posting) to finalize stop loss
reimbursements systematicaly
? Manage special accommodation product as required
? Back up duties to support the stop loss team (e.g. PTO, Absences,
Managing Work Loads, etc.)
? Other duties as assigned and determined by Stop Loss
management
Background/Experience Desired
? Stop Loss experience preferred
? Claims processing background preferred
? Ability to work independently and maintain service standards
? Technical and Analytical skills
? Proficiency in oral and written communications
Education and Certification Requirements
High School or GED equivalent
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected
veteran status.
Keywords: , Coon Rapids , Benefits Consultant -, Professions , Minneapolis, Minnesota
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