Stop Loss Specialist

Imagine360 is currently seeking a Stop Loss Specialist to join our 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, research, and resolves stop loss carrier questions.
• Facilitates advancement funding with Finance Department.
• Complies with reporting and documentations 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.
  
  
  

Required Experience / Education:

• High School Diploma or equivalent.
• 1+ years' experience in clerical and customer service.
• Knowledge of medical terminology.
• Stop loss, claims and/or health insurance experience is preferred.
  
  
  

Knowledge, Skills, and Abilities:

• Demonstrate organizational skills, problem-solving, critical thinking, analytical skills and strong attention to detail.
• Ability to reconcile funding accounts and transactions.
• Proficient knowledge of Microsoft Office.
• Ability to follow-up on work assigned and obtains proper review and approval.
• Proficient in communication and interpersonal skills.
• Ability to meet deadlines, handle stress, interacts professionally and positively with others.
  
  
  

What can Imagine360 offer you?

• 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
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives
  
  
  

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited, and no fee will be payable. Thank you for your cooperation**