Manager – Stop Loss

October 30

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

💵 $70k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Allied Benefit Systems

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Healthcare Insurance • B2B

Allied Benefit Systems is a national healthcare solutions company that provides health plan administration, care and cost management, provider network services, and data analytics to employers, members, and benefits consultants. The company focuses on reducing healthcare costs, optimizing plan performance, and improving member experience through administrative services, analytics & insights, and customizable provider networks.

201 - 500 employees

Founded 1980

⚕️ Healthcare Insurance

🤝 B2B

📋 Description

• Manage the day-to-day operations of the Stop Loss department. • Work closely with the Director, Stop Loss to establish and meet expectations and business goals. • Focus on innovation, ensuring audit metrics are kept, tracking stop loss claim filings, reimbursements, and advance funding claims. • Ensure all administrative, organizational, and auditing functions are maintained by the team. • Proactively address critical issues and identify ways to streamline and improve efficiency. • Monitor all claim filings, including both specific and aggregate. • Collaborate cross departmentally to ensure business objectives and performance standards are met. • Assess current processes and procedures for innovative opportunities. • Design and implement policies and procedures to align with corporate directives and strategies. • Ensure all defined processes and quality standards are followed. • Foster a sense of urgency and commitment to achieve goals. • Maintain direct report assignments, performance management, and relative goals. • Perform weekly audits of specific claims to ensure all claims were filed correctly and all reimbursements have been received. • Coordinate reprocessing of claims according to carrier negotiations. • Responsible for the filing of aggregate claims and securing reimbursements. • Assist with making claim adjustments for claims paid in a current contract but should be applied to a prior contract. • Lead, coach, motivate, and develop team members.

🎯 Requirements

• Bachelor’s degree or relevant work experience required • At least 5 years stop loss experience required, either at a TPA or stop loss carrier. • At least 3 years at a supervisory level and possess successfully demonstrated leadership competencies required. • Intermediate level work experience with Microsoft Office, Word, Excel, and Power Point software applications required • Group Health Insurance/Benefits experience preferred • Excellent written and verbal communication skills.

🏖️ Benefits

• Medical • Dental • Vision • Life & Disability Insurance • Generous Paid Time Off • Tuition Reimbursement • EAP • Technology Stipend