Now is the time to join us!
We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
Who are you?
The Stop Loss Specialist, tracks, monitors, and documents, stop loss claims submissions. Provides additional information to the carrier as needed and tracks the receipt of reimbursements from carriers and the transitions of reimbursement funds. This position maintains a comprehensive understanding of the plan document(s). Their scope of responsibility includes underlying stop loss contracts and terms.
In this role you will wear many hats, but your knowledge will be essential in the following:
- Research, review and handle carrier requests for claims submission timely.
- Follow stop loss contracts, procedures and guidelines.
- Monthly reconciliation of groups.
- Maintain, track, and post claim reimbursements.
- Review individual stop loss contracts.
- Review and send weekly innovative notices to carrier.
- Special monthly review and preparation of stop loss reports to include RX.
- Special monthly review and preparation of outstanding stop loss reimbursement report.
- Submit appeals to stop loss carriers as needed.
- Provide outstanding customer service to internal and external clients/brokers.
- Completes other projects as assigned.
- Ability to read and understand contracts - Reinsurance contracts and Summary Plan Descriptions.
- Ability to meet assigned deadlines.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
What you bring to the Personify Health team:
In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
- High school diploma or general education degree (GED) required.
- Knowledge of medical terminology, CPT, HCPCS and ICD-10 codes a plus.
- Prior experience in a healthcare related field a plus.
- Experience with claims/call center health insurance environment a plus.
- Experience in self-funded plan administrations a plus.
You also take pride in offering the following Core Skills, Competencies, and Characteristics:
- Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Excel and Outlook.
- Strong written and verbal communication skills.
- Proficient in Word, Excel, and outlook.
- Ability to organize, prioritize, and multitask in a fast-paced/deadline driven environment.
- Demonstrate ability to work independently with excellent judgment.
- A detail-oriented, analytical, financially minded approach.
- Capacity to think creatively and strategically.
- Claims processing experience or medical background a plus.
No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $17.00 to $23.00. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.
We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.
#WeAreHiring #PersonifyHealth #Remote
Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.
Application Deadline: Open until position is filled.
