We are looking to add a Stop Loss Claims Consultant to join our Avant team in Kansas City, MO, Minneapolis, MN or our Dallas, TX office.
Candidates thrive in our environment when they harness their collaborative mindset, strong interpersonal communication skills, and a love of learning.
The Stop Loss Claims Consultant at Avant will be responsible for Claims oversight of TPAs and insurance carriers.
Acts as the Avant advocate and intermediary/liaison between TPA, broker, and our clients.
Assists in management oversight of claims operations and department.
Responsibilities: Acts as member and agency partner liaison.
Participates in member claim reviews.
Conducts TPA satisfaction surveys.
Conducts monthly claim and reimbursement reporting on inforce customers.
Performs annual year-end stop loss claim reimbursement audits for clients.
Logs running record of service issues and follows through to completion.
Participates in new group calls with TPA, ASO and Carriers, as applicable.
Ensures special handling instructions are developed.
Assists with annual review of stop loss carrier RFIs and responses.
Works with TPA, ASO and Carriers on opportunities for improvement as identified on audits and surveys.
Regular follow-up with groups as issues are identified Participates in event education meetings and calls.
Participates in open claim reviews as needed by consultant or client.
Assists with mid-year claims stewardship for consulting team and the client.
Team Duties: Develops and maintains positive working relationship with consulting partners, stop loss team partners, and carrier partners Shares claims related issues with Sr. Risk Consultant, Operations Manager, and Director of Stop Loss Services.
Supports Avant structure and culture.
Knowledge, Skills and Abilities: Working knowledge of self-funded medical insurance and the ability to apply that knowledge in the performance of job duties.
Working experience in standard and complex stop loss claim reimbursements Excellent communication skills and the ability to apply these skills in either verbal or written form when interacting with various clients, company personnel and team members.
Ability to work effectively both independently as well as in a team environment to attain team and company goals.
Excellent organizational skills and the ability to manage multiple tasks/duties simultaneously.
Working knowledge of various software packages such as, word, excel, and PowerPoint.
Ability to perform simple to complex mathematical calculations.
Ability and willingness to participate in internal and external educational opportunities to enhance knowledge of current insurance topics or relevant system improvements.
Ability to keep current on industry trends and develop relationships with contacts within the industry.
Ability to work daily and extended hours as necessary.
Ability to assist in other work-related duties as necessary.
Ability to travel as needed.
Capable of exercising discretion in confidential matters and use independent judgment.
Must be knowledgeable of and comply with HMA' s Client Privacy Policy, HIPAA regulations and E&O procedures and policies.
Qualifications: Education: Minimum of high school diploma or equivalent.
Some college or college degree preferred.
Experience:Minimum 5 years' experience with managing medical and prescription drug claims with an emphasis in providing exceptional customer/client service.
Experience with medical stop loss claims insurance preferred.
Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey!
Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow.
401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k.
This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf!
We are forward-thinking and want to be sure your future is cared for.
Flexible work arrangements and schedules - We truly want to know what works for you as we look to support your unique and full potential.
Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do.
After all, you can't be at your best for our clients if you're not at your best for yourself first.
Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you.
DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us.
Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group.
You will have the opportunity to take part in those if you wish!
Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing.
Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money.
Who doesn't love that?!
Holmes Murphy & Associates is an Equal Opportunity Employer.
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