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Stop Loss Analyst - job 1 of 2

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We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

As a Stop Loss Analyst, you will serve as a key leader with ownership of end-to-end stop loss policy administration for Centivo’s self-funded clients and working with various internal departments (including Client Success, Implementation, Claims Operations, Member Care and Sales).

You will ensure timely reporting and stop loss claim filing with various carriers on specific and aggregate stop loss filings.

Responsibilities Include:

Monitor members approaching/exceeding spec, including policies with advance funding
Monitor clients approaching/exceeding aggregate, including policies with accommodation
Generate various reporting and reviews for accuracy before distribution, both internally and externally, as assigned.
Gather supporting documentation from both internal and external entities.
Compile stop loss claim filings, to include all supporting information/documentation, and submit to the stop loss carrier to maximize reimbursement
Manage filings, through reimbursement, to include consideration of policy filing limitations
Communicate regularly with various departments, external vendors, clients, and carriers.
Validate filing denials and appeals when necessary, to ensure our clients are receiving the maximum reimbursement allowed under the policy
Process an average of 4 to 5 claims per day, maintaining a processing accuracy of 99% or better
Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
Elevate issues to the next level of supervision, as appropriate
Other duties as assigned

Qualifications:

Required Skills and Abilities:

4 years of stop loss claims experience
Prior experience handling first dollar payer insurance (medical healthcare claims)
Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
Associates degree required; Bachelor’s degree preferred
Detail oriented with a high degree of accuracy and ability to multitask
Ability to accept changing priorities with a minimum of disruption
Strong problem solving, decision-making, reporting and analytical skills
Must possess good judgment and work effectively with internal business areas, peers and co-workers
Ability to work independently, prioritize, organize and assign your own work to meet deadlines
Demonstrated proficiency in Microsoft Excel

Preferred Qualifications:

El Dorado/Javelina experience
Ringmaster Smart-LinQ Experience

Work Location:

This position is remote

Centivo Values:

Empathy - We treat your problem as if it is our problem. Because it is. We are always glad to help because we care.
Resourcefulness - If it needs to be done, we’ll figure it out and get it done, or make sure it gets done.
Integrity - We do the right thing. Always. That includes placing people before profits.
Possibility - We start with Yes.
Reliability - We will always do what we say we will. You can count on us. Every single time.
Teamwork & Collaboration – We treat each other with respect and listen, support and value each other’s opinions as we work toward our shared goals.

Who we are:

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.

Average salary estimate

$70000 / YEARLY (est.)

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$60000K

$80000K

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What You Should Know About Stop Loss Analyst, Centivo

Are you passionate about making a real impact on the healthcare industry? Centivo is on a mission to provide affordable, high-quality healthcare for all, and we need a dedicated Stop Loss Analyst to join our team! Based in Buffalo, this remote position will have you at the forefront of managing end-to-end stop loss policy administration for our self-funded clients. As a part of our diverse team, you’ll collaborate with various internal departments such as Client Success, Implementation, and Claims Operations to ensure timely reporting and submissions for stop loss claims. Your day-to-day will involve monitoring members and clients approaching specific thresholds, generating precise reporting, and gathering crucial documentation to maximize reimbursements. With your prior experience in stop loss claims and medical billing practices, you'll expertly navigate and validate claims, ensuring our clients receive the benefits they deserve. We pride ourselves on our values of empathy, integrity, and teamwork, which guide our every action as we strive to create a better healthcare system. If you’re detail-oriented, a master at multitasking, and ready to embrace the challenge of optimizing healthcare expenses, then Centivo is the place for you. Let’s make a difference together by bringing possibility to our clients and employees alike!

Frequently Asked Questions (FAQs) for Stop Loss Analyst Role at Centivo

What are the main responsibilities of a Stop Loss Analyst at Centivo?

As a Stop Loss Analyst at Centivo, your main responsibilities include managing end-to-end stop loss policy administration, monitoring members and clients for specific thresholds, compiling and submitting stop loss claim filings to carriers, and ensuring accurate reporting. You'll be communicating regularly with different departments and external vendors while working to validate claims and maximize reimbursements for self-funded clients.