Senior Stop Loss Claims Examiner Hi, we're Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A Little More About Us: · We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space. · We are quickly becoming one of the fastest growing health benefits companies in the country. We have received numerous awards and accolades, including Inc. Magazine Best in Business Gold Medal award in 2021, and JMP Securities Top 50 Private Companies in Insurtech in 2022. · We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized. · Our customers like us. Our revenue churn is in the low single digits, in an industry where greater than 20% churn is common. · Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way. A Little More About The role: We're looking for a Senior Stop Loss Claims Examiner to join our team. The primary responsibilities for this position include reviewing and paying Stop Loss claims accurately and awesomely for a quickly growing and innovative insurance company. You will: · Examine and evaluate Specific Stop Loss claim submissions according to Stop Loss Claims procedures and methodology. · Ensure that Stop Loss Claims are paid correctly under the terms of the Stop Loss Policy and Underlying Plan · Communicate payment and denial decisions in a clear and professional manner. · Appropriately escalate difficult issues up the chain of command · Provide outstanding customer service and collaborate with other departments, management, and external partners. · Generating reports on stop-loss claims activity to assist others on risk management strategies. · Develop and enhance claim procedures and processes. · Create and submit Reinsurance submissions for Gravie's Reinsurers, follow through and advise the reimbursed amounts to finance. · Provide guidance and training to junior Stop Loss examiners on claim review processes, policy interpretation, and best practices when needed. · Assist Supervisor in quality assurance audits to ensure adherence to company standards. · Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented. You bring: · Bachelor's Degree or equivalent work experience · 5 + years of substantial experience in processing Medical Claims · Previous Stop Loss experience with a TPA or a Carrier · Working knowledge of insurance terminology and medical coding · Demonstrated problem-solving, organizational, and analytical skills. · Excellent communication skills · Ability to work independently, prioritize workloads, and multi-task. Extra credit: · Previous experience with Stop Loss Claims Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie's package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.
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