Lead Stop Loss Representative
Attend operational/technical meetings as content relates to stop loss.
Analyze monthly stop-loss reports and claims paid to identify data variances.
Investigate variances and identify the root cause.
Manage escalated inquiries to resolution.
Manage all production/issue tickets to initiate investigations into operational issues.
Perform weekly/monthly reconciliations.
Manager Index portal user access for new and existing updates as needed.
Manage external pbm data files. Point contact person to manage and address open issues to resolution.
Manage stop loss contracts. Add new/renewal contracts to the stop loss system.
Collaborate closely with the technical team to assist and answer questions as it relates to stop loss.
Manage a book of business as it relates to stop loss processing.
Participate on cross-functional project teams to as it relates to stop loss.
Identify processing gaps and work with appropriate departments to resolve.
Work with knowledge management to develop and maintain department procedures.
Work across teams to provide stop loss guidance as needed.
Assist team members with open inventory items as needed.
Train team on new and refreshed/updated processes.
Operate as back up to existing team lead as needed.
Perform additional tasks as needed.
8+ years of stop loss or claims experience
Critical thinking skills
Experience working in an operations environment.
Foster healthy working relationships within the team and across the business
Professional written and verbal communication skills
Strong thoroughness and organizational skills
Time management skills
Training experience is a plus
Workload Management skills
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.