First Choice Health
Washington
EXCESS LOSS ANALYST
POSITION SUMMARY:
The Excess Loss Analyst is responsible for the timely and accurate management of TPA clients’ Stop Loss contracts. This includes monthly reporting, preparing notifications and submissions, coordinating advance funding requests, and the creation of reports to support the Stop Loss renewal processes. .
EXAMPLES OF DUTIES:
- Monitor weekly claims activity and identify eligible stop loss claims based on each TPA client’s stop loss contract terms using HCA developed tools
- Responsible for understanding stop loss contract changes. Maintaining related internal tables of these terms used for reporting
- Submit required notification and submission information related to eligible claims when they occur. Notification may occur outside of claim activity, such as via Medical Management
- Track submissions and stop loss funds received
- Produce and distribute monthly reporting and renewal packages to Stop Loss Carriers
- Work with the Claims Department for Advance Funding Submissions and release of claims once funds are received
- Working with outside vendors for subrogation and COBRA.
- Be an internal advocate for Stop Loss submission requirements and issues, working with other departments as needed.
- Work with HCA team members for any tool improvements
- Performs other work as assigned.
QUALIFICATIONS:
- Ability to learn reinsurance practices, interpret stop loss contracts, FCH claims processing and related Medical Management activities
- Minimum of 3-5 years of claims handling or related TPA experience
- Proven organizational and research skills with diligence to details, preference for mathematics or auditing background
- Strong written and verbal communication skills..
- Strong analytical problem-solving skills
- Ability to work with PHI and send secured electronic transfer of files.
- Ability to work independently or as a member of a team.
- Experience with Google and/or Microsoft Office products
- Knowledge of medical terminology and ICD-9 and CPT coding, preferred.
- Bachelor’s Degree preferred.
PHYSICAL REQUIREMENTS:
- Ability to sit for long periods of time.
- Ability to see and hear within normal ranges, with or without aids.
- Ability to speak clearly.
- Hand and finger dexterity within normal ranges.
Access to PHI:
Routine & re-occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI.
Pay Range: $60K – $74K annually
Diversity, Equity & Inclusion:
At First Choice Health we are thoughtful about the words we use and the actions we take. We intentionally hire people from diverse backgrounds who help us think differently and challenge status-quo thinking. Our commitment to Diversity, Equity, and Inclusion allows us to strive to make healthcare easier to access for everyone in all walks of life.
Benefits:
- Medical & Vision- We offer two medical plans for employees, High Deductible and PPO plan for employees to choose from.
- Dental – A dental plan through Sun Life Dental is available to employees and eligible dependents.
- Health Savings Account (HSA)- Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.
- Flexible Spending Account (FSA) – Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not roll over from year to year.
- Life Insurance – FCH provides life insurance benefits at no cost at a limit of two times an employee’s annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.
- Short & Long-Term Disability Insurance – FCH provides long-term and short-term disability coverage to all employees. It is a shared cost-benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.
- Personal Leave and Sick Time – FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service – 120 hours; 1-2 years of service – 136 hours; 3 + years of service – 168 hours.
- Paid Holidays – Each employee receives two floating holidays Employees receive nine paid holidays, two four-hour time blocks for community service per year, and two floating holidays (granted January 1 and July 1).
- Employee Assistance Program (EAP)- FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.
- Retirement Plan 401(k) – We contribute 50% of the employee’s 401k deferral, up to a maximum of 3% of the employee’s gross salary. Eligible employees must be at least 21 years old, and be employed with FCH a minimum of 90 days.
- Profit Sharing – FCH may make annual discretionary profit-sharing contributions in an amount to be determined at Plan Year-end.
- Tuition Reimbursement – Employees may be eligible to receive reimbursement for continuing education for Bachelor’s program after one year of employment with the company.
- Wellness – We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.
- These benefits may be changed with or without notice at any given time.
For California employees, please review the Privacy Act: https://www.fchn.com/documents/fch/pdf/caprivacynoticeemployeesandapplicantsfinal8-23-20231.pdf
Source ⇲
Related Jobs
-
Annuity Distribution Intern (Remote)
TruStageRemote -
Claims – Special Investigations Unit Intern (Remote or Hybrid)
TruStageMadison, WI -
Claims Intern – Business Protection (Remote or Hybrid)
TruStageMadison,WI (Remote) -
Corporate & Legislative Affairs Intern (In-person or hybrid)
TruStageMadison, WI (Remote)
