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Under the guidance of the Vice President of Sales Operations, The Stop Loss Manager will be responsible for overseeing and ensuring the completion for an end to end stop loss administration policy for Centivo’s self-funded clients. This includes but is not limited to specific claimant identification, completion of notification forms, reporting on high-cost claimants and clinical reports to the stop loss carrier, and claims filing to ensure Centivo meets its contractual and administrative responsibilities.

Team Management-Development

• Monitoring and managing the team’s assignments, including resource balancing. (Please note this is a working manager position where the candidate will work hand-in-hand with their team members to complete the required work.)
• Developing policies, processes and procedures to further improve the department’s services
• Defining staffing ratios and further define roles and responsibilities with the department
• Lead the development\management of any new functionality and workflows to improve efficiency and automate current manual processes
• Ensure knowledge transfer and training is delivered, retained and reinforced

Responsibilities Include:

• Be responsible for overseeing the stop loss management team completes the end-to-end stop loss claim processes and procedures are completed, filed and reimbursed timely for all stop loss funding, reporting and policies.
• Ensure the business requirements for the configuration and management of Centivo’s stop loss administration software system is accurate and up to date and be responsible for the successful implementation and execution of those requirements.
• Work cross functionally with Stop Loss Coordinators, and all key stakeholders to ensure information and timely decisions are being made for the benefit of our client and organization.
• Work with the Vice President of Sales Operations to adjust processes, identify and source tools, manage staffing needs (new positions and training), and collaborate with internal teams as necessary for items requiring escalation.
• Maintain a process for identifying potential specific claimants within each client’s utilization data including collaboration with other key departments and monitor specific claimants in a timely fashion.
• Manage specific and aggregate claim submission processes, acting as liaison between Centivo and its stop loss carrier partners:
  • Ensuring new carriers have Non-Disclosure Agreements in place before sharing any client data
  • Providing stop loss carrier with necessary information required for claim reimbursement consideration and appeal submissions.
  • Requesting changes to stop-loss policy and/or client SPD as needed to ensure seamless coverage
  • Participating in internal workgroups and task force(s) as needed to successfully implement stop loss administration
• Collaborate with Sales, Client Success and/or other internal department(s) for the management of renewal quote requests
• Complete all renewal paperwork including stop-loss proposal, stop loss application, and stop loss contract, then submit/save items to appropriate parties/locations
• Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement.
• Generate timely and accurate financial data for monthly report submissions
• Proactively reviews weekly reports to identify potential high-cost claimants
• Participate actively in team and department meetings on stop loss administration process, client/product implementation planning as it may relate to stop loss management
• Ensure stop loss industry knowledge is current, bringing forward ideas and recommendations to ensure Centivo has a competitive position in the marketplace
• Training new hires and teaching the necessary workflows and processes established, and creating and maintaining document outlining current state policies and procedures
• Performs other miscellaneous projects, assignments, and duties as assigned by management

Required Knowledge, Skills and Abilities:

• Strong leadership and team management skills
• Demonstrated abilities with process development and improvement as well as change management
• Excellent oral and written communications; an ability to present information in a way that establishes rapport, persuades others, gains understanding
• Ability to anticipate the oncoming workload, identify barriers, and ensure all required work is completed timely
• Advanced knowledge of Microsoft Office products (Excel, PowerPoint, Word)
• Strong customer service, organizational and time management skills
• Demonstrated ability to meet performance goals, including accuracy and productivity
• Ability to access, operate, and maintain various software applications
• Ability to work independently with minimal supervision
• Demonstrated commitment to Centivo’s mission and values

Education and Experience:

• 10 years of experience in stop loss policy management and/or financial claims analytics required
• Bachelor’s degree required
• Stop Loss policy and administrative management and marketing experience required, specifically with self-funded insurance
• Knowledge of the stop loss claims/submission and stop loss carrier reporting needs

Preferred Qualifications:

• Ringmaster experience

Work Location:

• This position is work from home or Buffalo office