免赔额文件协调员
Stop Loss Filing Coordinator
Point C 是一家全国性的第三方管理机构（TPA），在本地市场有业务存在，提供定制化的自付费用福利计划。我们致力于超越市场上的常规解决方案，为客户提供更多价值，并帮助他们超越传统的“从A点到B点”的模式。我们研究了最有效的成本控制策略，并通过创新的解决方案，如网络和支付完整性、药品福利和护理管理，降低计划成本。许多公司都有使命，而我们是一家拥有使命的公司。
Point C 正在寻找一位注重细节且有条理的停赔文件协调员加入我们不断壮大的团队。该职位在管理整个停赔索赔流程中起着关键作用，是内部利益相关方、客户和停赔承保人之间的联络人。理想的候选人能够在以截止日期为导向的环境中工作，具备出色的沟通和分析能力，并能熟练处理复杂的政策文档和索赔数据。
主要职责：
- 专注于准确性和资格验证，准备并提交停赔索赔及支持性文件。
- 与内部团队、客户和停赔承保人协调，确保索赔提交及时且完整。
- 精确记录所有索赔活动，包括往来信函和支持性文件。
- 作为内部团队与停赔中介/承保人之间的主要联系人。
- 定期向客户和内部利益相关方报告索赔状态、待解决问题和解决时间表。
- 与客户经理和销售执行人员合作，支持报价续签和保单审查。
- 审核和分析停赔保单、报价、申请和计划文件，确保一致性和一致性。
- 生成用于内部和客户使用的月度财务数据报告。
- 维护和更新内部停赔索赔活动的跟踪电子表格。
- 识别停赔文件流程的优化机会，提高整体效率。
- 参与内部审计，并为团队培训和最佳实践开发做出贡献。
- 协调客户和停赔承保人，处理高级资金请求。
- 支持更广泛的停赔行政职能，并确保符合内部政策和监管要求。
任职资格：
- 具备较强的关注细节的能力
查看英文原文
Point Cis a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
Point C is seeking a detail-oriented and organized Stop Loss Filing Coordinator to join our growing team. This position plays a critical role in managing the end-to-end stop loss claims process, serving as a liaison between internal stakeholders, clients, and stop loss carriers. The ideal candidate thrives in a deadline-driven environment, demonstrates exceptional communication and analytical skills, and is comfortable navigating complex policy documentation and claim data.
Primary Responsibilities:
- Prepare and submit stop-loss claims and supporting documentation with a focus on accuracy and eligibility verification.
- Coordinate with internal teams, clients, and stop-loss carriers to ensure timely and complete claim submissions.
- Maintain precise records of all claims activity, including correspondence and supporting documentation.
- Act as the primary point of contact between internal teams and stop-loss MGUs/carriers.
- Provide regular updates to clients and internal stakeholders regarding claim status, pending issues, and resolution timelines.
- Collaborate with Account Managers and Sales Executives to support quote renewals and policy reviews.
- Review and analyze stop-loss policies, quotes, applications, and plan documents to ensure alignment and consistency.
- Generate monthly financial data reports for internal and client-facing use.
- Maintain and update internal tracking spreadsheets for stop-loss claims activity.
- Identify opportunities to streamline stop-loss filing processes and enhance overall efficiency.
- Participate in internal audits and contribute to team training and best practice development.
- Manage advanced funding requests in coordination with clients and stop-loss carriers.
- Support the broader stop-loss administrative function and ensure compliance with internal policies and regulatory requirements.
Qualifications:
- Strong attention to detail and organizational skills with the ability to manage multiple tasks and deadlines.
- Experience working in healthcare, insurance, or third-party administration (TPA) settings, particularly in stop-loss claims or underwriting.
- Proficiency in Microsoft Office Suite, especially Excel for tracking and reporting.
- Strong verbal and written communication skills for both internal and external correspondence.
- Ability to interpret complex policy language and reconcile information across multiple documents.
- A proactive, problem-solving mindset and commitment to continuous process improvement.
- Prior experience working with stop-loss MGUs or carriers is a plus.
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
Pay Transparency
$45,000—$50,000 USD
Benefits:
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
Originally posted on Himalayas