Stop Loss Training Lead

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $65k - $73k / year

⏰ Full Time

🟠 Senior

📚 Learning and Development

👻 Ghost score 0%

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Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• Serve as the department’s subject matter expert on stop loss administration, reimbursement, and contract interpretation • Review stop loss contracts, plan documents, and carrier requirements to ensure compliance and capture reimbursement opportunities • Support submission, tracking, and reconciliation of stop loss claims • Work aging items, carrier inquiries, disputes, and escalated cases through closure • Audit claim submissions, reimbursement tracking, documentation, and correspondence for accuracy and completeness • Report audit results and performance metrics to leadership • Identify recurring errors, trends, and process gaps and develop corrective action recommendations • Partner with leadership to implement corrective actions • Onboard Stop Loss Specialists and create and maintain training materials and standard operating procedures • Deliver coaching and refresher sessions • Evaluate workflows and lead or support process improvement initiatives • Help roll out new tools and best practices, including testing and validating system updates • Review and help prepare monthly stop loss and reimbursement reporting and carrier submissions • Support internal and external audit requests and maintain accurate documentation • Process stop loss claims and handle related operational work as needed • Contribute to special projects advancing department goals

🎯 Requirements

• High School Diploma or equivalent required • Associate’s or Bachelor’s degree preferred • 3-5 years of experience in stop loss, self-funded health plan administration, claims, or related healthcare required • Advanced claims processing and reimbursement experience strongly preferred • Experience interpreting stop loss contracts and plan documents preferred • Experience conducting audits, quality reviews, or process improvement initiatives preferred • Experience training or mentoring team members preferred • Advanced knowledge of stop loss administration, reimbursement processes, and contract interpretation • Working knowledge of medical terminology and CPT, HCPCS, and ICD-10 coding preferred • Proficiency in Microsoft Excel, Word, Outlook, and reporting tools • Auditing and data analysis skills, including identifying trends and building data-driven recommendations

🏖️ Benefits

• Competitive base salary • Benefits effective day one • Comprehensive medical and dental through Personify Health’s own health solutions • Unlimited PTO • Mental health support • Retirement planning • Financial protection • Professional development with clear career progression and learning budgets • Mission-driven culture where diverse perspectives drive real impact • Wellness programs • Other employee perks

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