Stop Loss Manager

POSITION SUMMARY

The Stop Loss Manager is responsible for managing the day-to-day operations of the Stop Loss department. This position will work closely with the Director, Stop Loss to establish and meet expectations and business goals. The Manager will focus on innovation, ensuring audit metrics are kept, tracking stop loss claim filings, reimbursements, and advance funding claims to ensure the department is running in an efficient and thorough manner. Ensuring all administrative, organizational, and auditing functions are maintained by the team.

ESSENTIAL FUNCTIONS

• Manages the day-to-day operational functions to include, workflow management, staffing needs, systems, procedures, and reporting.
• Proactively addresses critical issues and identifies ways to streamline and improve efficiency of work
• Monitor all claim filings, including both specific and aggregate.
• Collaborate cross departmentally to ensure business objectives and performance standards are met.
• Assesses current processes and procedures for innovative opportunities amongst teams.
• Design and implement policies and procedures most efficient to corporate directives and strategy.
• Ensure all define processes and quality standards are followed.
• Foster a sense of urgency and commitment to achieve goals
• Ability to troubleshoot daily issues that arise throughout each team.
• Maintain direct report assignments, performance management and relative goals.
• Perform weekly audits of specific claims to ensure all claims were filed correctly and all reimbursements have been received.
• Coordinate reprocessing of claims according to carrier negotiations
• Request reporting for mid-year takeover stop loss policies
• Responsible for the filing of aggregate claims and securing reimbursements.
• Assist with making claim adjustments for claims paid in a current contract but should be applied to a prior contract.
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
• Actively engage, coach, counsel and provide timely, and constructive performance feedback.
• Work on special projects, duties or tasks as assigned.

EDUCATION

• Bachelor’s degree or relevant work experience required

EXPERIENCE AND SKILLS

• At least 5 years stop loss experience required, either at a TPA or stop loss carrier.
• At least 3 years at a supervisory level and possess successfully demonstrated leadership competencies required. 
• Intermediate level work experience with Microsoft Office, Word, Excel, and Power Point software applications required
• Group Health Insurance/Benefits experience preferred
• Excellent written and verbal communication skills

POSITION COMPETENCIES

• Accountability
• Communication
• Action Oriented
• Timely Decision Making
• Building Relationships/Shaping Culture
• Customer Focus

PHYSICAL DEMANDS

•    This is a standard desk role – long periods of sitting and working on a computer are required. 

WORK ENVIRONMENT  

• Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.