Stop Loss Analyst

Centivo Inc.

Job Overview

Location

Indiana, USA

Job Type

Full-time

Full Job Description

📋 Description

• As a Stop Loss Analyst at Centivo Inc., you will play a pivotal role in ensuring the financial health and operational efficiency of our self-funded client plans. This position is crucial for maintaining the integrity of our affordable, high-quality healthcare mission, directly impacting the well-being of workers and employers who form the backbone of our economy.
• You will take ownership of the end-to-end administration of stop loss policies, acting as a central point of contact and a key leader within the organization. Your responsibilities will span across various internal departments, including Client Success, Implementation, Claims Operations, Member Care, and Sales, fostering seamless collaboration and communication.
• A significant aspect of your role will involve cultivating and nurturing strategic relationships with Centivo’s stop loss carrier partners. You will work closely with their account managers, as well as with third-party administrators (TPAs), brokers, agents, and other vendors, to facilitate and successfully complete the critical stop loss renewal process.
• Under the expert guidance of our Stop Loss Manager, you will be instrumental in developing and maintaining a robust process for identifying potential specific claimants within each client’s utilization data. This proactive approach requires close collaboration with other key departments to ensure timely identification and vigilant monitoring of these high-cost claimants.
• You will meticulously manage the submission processes for both specific and aggregate claims, serving as the primary liaison between Centivo and its stop loss carrier partners. This includes ensuring that all necessary Non-Disclosure Agreements (NDAs) are in place before any sensitive client data is shared with new carriers.
• Your responsibilities extend to providing stop loss carriers with all the requisite information for claim reimbursement consideration and for supporting any appeal submissions. This demands a keen eye for detail and a thorough understanding of policy requirements.
• To ensure seamless coverage and compliance, you will be responsible for requesting necessary changes to stop-loss policies and/or client Summary Plan Descriptions (SPDs) as needed. This requires a deep understanding of both policy language and regulatory requirements.
• You will actively participate in internal workgroups and task forces, contributing your expertise to successfully implement and refine stop loss administration within our claims systems. This collaborative effort is vital for continuous improvement.
• A core duty involves the rigorous analysis of stop-loss policies, comparing them against the initial quote, application, and the official plan document to ensure absolute accuracy and agreement. Any discrepancies will need to be identified and addressed promptly.
• You will be responsible for creating and delivering comprehensive monthly reports to carriers, which include crucial data such as Aggregate Accommodations and Year-End Aggregate Filings. Accuracy and timeliness are paramount in these submissions.
• To enhance efficiency and meet both internal and carrier-specific goals, you will focus on scheduling and automating recurring reporting tasks, leveraging technology to streamline operations.
• Generating timely and accurate financial data for monthly report submissions is a key performance indicator for this role, directly impacting financial planning and carrier relations.
• You will proactively review weekly reports to identify potential high-cost claimants, enabling early intervention and cost management strategies.
• Active participation in team and department meetings is expected, focusing on the stop loss administration process and client/product implementation planning as it relates to stop loss management. Your insights will be invaluable.
• Staying current with stop loss industry knowledge is essential. You will be encouraged to bring forward innovative ideas and recommendations to ensure Centivo maintains a competitive edge in the marketplace.
• You will be tasked with conveying critical renewal information for stop-loss rates internally within Centivo, ensuring all relevant stakeholders are informed and prepared.
• Leveraging your developed understanding of all aspects of operational functions, you will efficiently perform to established service standards, particularly concerning renewals and client service.
• You will serve as a proactive communicator, elevating client issues and concerns to the appropriate Manager, Client Services and/or Account Management for swift resolution.
• Finally, you will perform other miscellaneous projects, assignments, and duties as assigned by management, demonstrating flexibility and a commitment to the company’s overall success.

🎯 Requirements

• 4 years of experience in stop loss, claims operations, financial analytics, customer service, or client services.
• Associates degree required; Bachelor’s degree preferred.
• Stop Loss policy management and marketing experience required, specifically with self-funded insurance and level-funded based client knowledge.
• Advanced knowledge of Microsoft Office Suite (Excel, PowerPoint, Word).
• Strong customer service, organizational, and time management skills.
• Excellent written, verbal, and interpersonal communication skills.

🏖️ Benefits

• Competitive salary and benefits package.
• Opportunity to work remotely, offering flexibility and work-life balance.
• Be part of an innovative company with a mission to make healthcare affordable and high-quality.
• Professional development and growth opportunities within a dynamic industry.

Skills & Technologies

Remote

Degree Required

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Centivo Inc.

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About Centivo Inc.

Centivo is a health plan administrator that partners with self-insured employers to provide affordable healthcare benefits. It builds custom networks of high-value primary care providers and specialists, emphasizing coordinated care, transparent pricing, and payment innovations like prospective bundled payments. The platform offers members digital tools for provider search, cost estimates, and care navigation, while giving employers predictable costs and data analytics to improve population health outcomes.

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