Benefits Consultant -

Location: Minneapolis
Posted on: October 29, 2024

Job Description:

Summary/Mission

Achieve superior Stop Loss performance through an integrated process of operational, cost and resource management meeting and/or exceeding plan sponsor and member expectations.

Position Summary/Mission

Acts as a liaison and subject matter expert between our internal and external clients and the stop loss administrators. Reviews and manages stop loss claim filings. Resolves discrepancies between the amount requested and the amount reimbursed by the stop loss carrier.

Fundamental Components and Physical Requirements include but are not limited to (*denotes essential function)

? Acts as principal point of contact for stop loss administrators (*)

? Review and investigate inquiries from stop loss administrators (*)

? Manage and/or request retro pre-cert reviews, medical necessity inquiries, medical records & physician orders, etc.(*)

? Utilize all applicable system functions and department relationships to finalize stop loss filings (*)

? Perform manual processes related to mid-year takeovers, plan year end, special handling clients, stop loss policy reviews, etc.(*)

? Review Actively at Work (AAW) eligibility documents prior to submission to stop loss administrator (*)

? Review and resolve mismatched filings prior to submission to stop loss administrator (retention review, aggregating-specific review, etc.) (*)

? Review, adjudicate and appeal as necessary mismatched stop loss reimbursements (*)

? May process filings on other claim platforms (e.g. Eldorado, LuminX)

? Maintaining good relationships with internal and external clients

? Escalate complex issues to Stop Loss Senior Analyst or Stop Loss Management as directed(*)

? Use system reporting tools to maintain and manage daily work flow (*)

? May perform processes (In/Out Posting) to finalize stop loss reimbursements systematicaly

? Manage special accommodation product as required

? Back up duties to support the stop loss team (e.g. PTO, Absences, Managing Work Loads, etc.)

? Other duties as assigned and determined by Stop Loss management

Background/Experience Desired

? Stop Loss experience preferred

? Claims processing background preferred

? Ability to work independently and maintain service standards

? Technical and Analytical skills

? Proficiency in oral and written communications

Education and Certification Requirements

High School or GED equivalent

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Plymouth , Benefits Consultant -, Professions , Minneapolis, Minnesota