Stop Loss Claims Analyst/Risk Management Specialist for TPA Healthcare Benefits

1 day ago


Burlington, United States Cobalt Benefits Group LLC Full time
Job DescriptionJob Description
Description:Stop Loss Claims Analyst/Risk Management Specialist

Full-time

Reports to Director of Stop Loss

Onsite/Hybrid


In this dynamic role, you will oversee the stop-loss insurance process, manage claims, coordinate with vendors, and ensure compliance with industry regulations. Your analytical mindset and industry knowledge will directly contribute to our clients' success and satisfaction.


Key Responsibilities


Claims Management: Analyze and process stop-loss claims to ensure accurate and timely reimbursements for eligible claims exceeding specific deductibles.• Vendor Liaison: Serve as the main point of contact with excess loss vendors, facilitating data submissions and resolving inquiries efficiently.

Data Analysis: Monitor claims data to identify trends and opportunities for enhancing the stop-loss program, ensuring our clients receive optimal support.

Reporting: Generate comprehensive monthly and year-end aggregate claims reports for internal stakeholders and external vendors.

Policy Compliance: Maintain adherence to regulatory requirements and best practices in all processes and documentation.

Client Engagement: Communicate proactively with clients regarding their stop-loss coverage and claims status, providing exceptional service and support.

Training and Development: Educate and support internal teams on stop-loss processes and industry best practices.


Requirements:

What We're Looking For


Education: Bachelor's degree in finance, business administration, healthcare management, or related field preferred.

Experience: At least 3 years in healthcare claims management or stop-loss insurance, with a proven track record of success.

Industry Insight: Strong understanding of stop-loss insurance policies and healthcare claims processing, with familiarity in medical terminology.

Analytical Skills: Exceptional analytical abilities, adept in data analysis and reporting tools.

Detail-Oriented: Precision and accuracy are paramount in managing claims and documentation.

Strong Communicator: Excellent verbal and written communication skills to engage effectively with clients, vendors, and colleagues.

Organizational Skills: Ability to manage multiple projects in a fast-paced environment, meeting deadlines with ease.



Why Join Us?


At Cobalt Benefits Group we offer more than just a job; we provide a pathway for your professional growth and development. Our comprehensive benefits package includes:


• Competitive medical, dental, and vision insurance.

• Company-paid Basic Life and AD&D insurance.

• Flexible Spending Accounts.

• 401(k) Retirement Plan with employer match.

• Generous paid time off and holidays.

• A culture of innovation, collaboration, and professional development




Equal Opportunity Employer, including disability/protected veterans

PI36fdebc9f7fc-25405-35889578



  • Burlington, Vermont, United States Cobalt Benefits Group LLC Full time

    Job SummaryWe are seeking a highly skilled Stop Loss Claims Analyst/Risk Management Specialist to join our team at Cobalt Benefits Group LLC. In this dynamic role, you will be responsible for overseeing the stop-loss insurance process, managing claims, coordinating with vendors, and ensuring compliance with industry regulations.Key ResponsibilitiesClaims...


  • Burlington, United States Cobalt Benefits Group LLC Full time

    Job DescriptionJob DescriptionDescription:Stop Loss Claims Analyst/Risk Management SpecialistFull-timeReports to Director of Stop LossOnsite/HybridIn this dynamic role, you will oversee the stop-loss insurance process, manage claims, coordinate with vendors, and ensure compliance with industry regulations. Your analytical mindset and industry knowledge will...


  • Burlington, Vermont, United States Cobalt Benefits Group LLC Full time

    Risk Management Specialist for Healthcare BenefitsJob SummaryWe are seeking a highly skilled Risk Management Specialist to join our team at Cobalt Benefits Group LLC. As a key member of our team, you will be responsible for overseeing the stop-loss insurance process, managing claims, coordinating with vendors, and ensuring compliance with industry...


  • Burlington, Vermont, United States Cobalt Benefits Group LLC Full time

    Job SummaryWe are seeking a highly skilled Risk Management Specialist for Healthcare Benefits to join our team at Cobalt Benefits Group LLC. As a key member of our team, you will be responsible for overseeing the stop-loss insurance process, managing claims, and ensuring compliance with industry regulations.Key ResponsibilitiesClaims Management: Analyze and...


  • Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    Make a Positive Impact in the Insurance SectorAt Cincinnati Insurance Company, we prioritize people and adhere to the Golden Rule in our operations. We are in search of exceptional individuals to enhance our skilled team.Our dedicated, ethical, and knowledgeable associates form the core of our mission to be the leading company serving independent agents. We...


  • Burlington, United States Diedre Moire Corp. Full time

    Insurance Underwriter OpportunityWe are seeking a skilled Insurance Underwriter to join our team at Diedre Moire Corp. in Burlington, VT. As an Insurance Underwriter, you will be responsible for evaluating and managing risk for our clients.Key Responsibilities:Evaluate and assess risk for commercial and personal lines insurance policiesDevelop and implement...

  • Claims Representative

    1 month ago


    Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    Job Title: Field Claims RepresentativeWe are seeking a highly skilled and motivated Field Claims Representative to join our team at Cincinnati Insurance Company, Inc.About the Role:The Field Claims Representative will be responsible for investigating and evaluating multi-line insurance claims in the field, ensuring accurate settlements and providing...


  • Burlington, North Carolina, United States City of Burlington, NC Full time

    Job Summary: We are seeking a highly skilled Insurance Claims Assistant to join our team at the City of Burlington, NC. As an Insurance Claims Assistant, you will be responsible for managing various aspects of our employee and retiree insurance programs. This includes maintaining accurate records, assisting with claims processing, and providing support to...


  • Burlington, United States Concord Group Insurance Full time

    Our role as a Field Claims Representative will be responsible for the investigation, evaluation and settlement of assigned claims involving 1st Party Homeowner and Commercial Property claims. This role is a field-based position and will require travel to loss sites to evaluate the damages. This also includes special investigation activities with an emphasis...

  • Claims Representative

    2 months ago


    Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    About UsCincinnati Insurance Company, Inc. is a leading provider of insurance solutions, dedicated to delivering exceptional service and value to our customers. We are committed to building strong relationships with our independent agents and policyholders, and we are seeking a talented Claims Representative to join our team.Job SummaryWe are seeking a...


  • Burlington, Vermont, United States Selective Insurance Full time

    About the RoleSelective Insurance is seeking a highly skilled Agency Management Specialist to join our team. As a key member of our organization, you will be responsible for developing and maintaining strong relationships with our agents, regional underwriting team, and corporate departments.Your primary objective will be to assess the strengths and...

  • Claims Investigator

    4 days ago


    Burlington, Vermont, United States Concord Group Insurance Full time

    Job SummaryWe are seeking a skilled Claims Investigator to join our team at Concord Group Insurance. As a Field Claims Representative, you will be responsible for investigating, evaluating, and settling assigned claims involving 1st Party Homeowner and Commercial Property claims.Key ResponsibilitiesInvestigate assigned claims – confirm coverage – verify...


  • Burlington, Vermont, United States Concord Group Insurance Full time

    Job SummaryWe are seeking a skilled Field Claims Adjuster to join our team at Concord Group Insurance. As a Field Claims Adjuster, you will be responsible for investigating, evaluating, and settling assigned claims involving 1st Party Homeowner and Commercial Property claims.Key ResponsibilitiesField appraise losses of all types for both personal lines and...

  • Claims Representative

    1 month ago


    Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    Make a Difference with a Career in InsuranceCincinnati Insurance Company, Inc. is a relationship-based organization that values diversity and promotes a lifelong learning approach. We're seeking extraordinary individuals to join our talented team as Field Claims Representatives.About the RoleAs a Field Claims Representative, you will investigate and evaluate...


  • Burlington, Vermont, United States PMA Companies Full time

    Job Title: Regional Claims SupervisorAs a Regional Claims Supervisor at PMA Companies, you will play a critical role in ensuring the successful execution of our claims management strategy. This position requires a strong leader who can motivate and guide a team of claims professionals to achieve business objectives and maintain compliance with regulatory...


  • Burlington, Vermont, United States LabCorp Full time

    Job Title: Healthcare Billing SpecialistLabCorp is seeking an entry-level Healthcare Billing Specialist to join our team in the Revenue Cycle Management Division. As a Healthcare Billing Specialist, you will play a critical role in improving health and improving lives by ensuring accurate and timely billing activities.Responsibilities:Billing Data Entry:...

  • Claims Representative

    2 months ago


    Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    About the RoleWe are seeking a skilled and detail-oriented Claims Representative to join our team at the Cincinnati Insurance Company, Inc. This is an exciting opportunity to work in a dynamic and customer-focused environment, where you will have the chance to make a real difference in the lives of our policyholders.Key ResponsibilitiesInvestigate and...

  • Claims Representative

    1 month ago


    Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    Make a Difference with a Career in InsuranceCincinnati Insurance Company, Inc. is a relationship-based organization that values diversity and promotes a lifelong learning approach. We're seeking extraordinary individuals to join our talented team as Field Claims Representatives.About the RoleAs a Field Claims Representative, you will investigate and evaluate...


  • Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    Make a Difference with a Career in InsuranceCincinnati Insurance Company, Inc. is seeking a talented Field Claims Representative to join our team. As a Field Claims Representative, you will be responsible for investigating and evaluating multi-line insurance claims, providing exceptional customer service, and working collaboratively with our independent...


  • Burlington, Vermont, United States Cincinnati Insurance Company, Inc. Full time

    Field Claims Representative OpportunityWe are seeking a skilled Field Claims Representative to join our team at Cincinnati Insurance Company, Inc. As a Field Claims Representative, you will be responsible for investigating and evaluating multi-line insurance claims in the field.Key Responsibilities:Conduct thorough claim investigations and interviews with...