Stop Loss Representative
Description
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that 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. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the 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.
The Stop Loss Representative will perform activities related to managing inventory, filing submissions to stop loss carriers for reimbursement, distribute monthly stop loss reporting to appropriate contacts, auditing reports for accuracy prior to issuing, maintain detailed tracking and storage of supporting documentation, attend meeting with account management, brokers, and/or support team as needed to answer questions and/or resolve issues. This includes but is not limited to projects, updating claimant id numbers/merge multiple records to track all stop loss claim dollars, processing external pbm files and additional duties assigned to support the team as needed.
Responsibilities
- Manage Inventory
- Distribute monthly reports.
- Process PBM rx files
- Follow up on all open items timely.
- Reconcile accounts, communicate discrepancies immediately.
- Manage working relationships with internal and external business partners.
- Attend meetings to resolve issues as needed.
- Perform other duties as necessary or appropriate for the position.
Qualifications
- Bachelor’s degree in business operations or equivalent work experience
- More than two years working in an operations environment
- Knowledge of claims processing preferred
- Previous experience in Stop Loss or healthcare experience preferred
- Experience working in a production driven environment
- Self-starter, highly motivated problem solver with the ability to work independently.
- Ability to multi-task and handle deadline driven assignments
- Ability to perform appropriate research, make responsible decisions and demonstrate customer-oriented professionalism.
- Strong organization skills and attention to detail capabilities are required.
- Strong communication and competency skills are necessary
- Ability to follow documented procedures and instructions
- Cross-functional team collaboration skills desired
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that 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. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the 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
Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.