Claims Management Lead

3 weeks ago


Charleston, West Virginia, United States The Health Plan of West Virginia Inc Full time

Job Title: Claims Management Lead - Stop Loss Specialization

About Our Organization:

The Health Plan of West Virginia Inc is a leading provider of healthcare services. We are committed to delivering exceptional patient care and innovative solutions. As a Claims Management Lead - Stop Loss Specialization, you will play a critical role in managing stop loss claims to ensure timely, complete, and accurate administration.

Salary Range: $95,000 - $140,000 per year

Job Description:

You will work closely with internal and external stakeholders to deliver customer-focused administration of stop loss claims, maintaining favorable relationships with Stop Loss Carriers, Brokers, and Account Management staff, UR/LCM vendors, and PBMs. Additionally, you will mentor and develop Stop Loss Analyst staff and Reinsurance Specialist staff through knowledge transfer, exposure to carriers and markets.

Key Responsibilities:

  • Manage stop loss claims to ensure timely, complete, and accurate administration
  • Coordinate with internal and external stakeholders to deliver customer-focused administration of stop loss claims
  • Maintain favorable relationships with Stop Loss Carriers, Brokers, and Account Management staff, UR/LCM vendors, and PBMs
  • Mentor and develop Stop Loss Analyst staff and Reinsurance Specialist staff

Requirements:

  1. Bachelor's degree or equivalent work experience
  2. Five years or more of progressive responsibility with increasing levels of managerial expertise and responsibility in analysis of Stop Loss Insurance and Stop Loss claims administration
  3. Must be thoroughly familiar with current health insurance market trends, services, contracts, and pricing procedures
  4. Ability to analyze and understand insurance contracts, terms, provisions, limitations, and exclusions


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