Stop - Loss Account Analyst/ Coordinator (Job ID: 1272), MVP Health Care

Posted: 04/03/18 | SHARE:

Description:

MVP Health Care is a nationally-recognized, regional not-for-profit health plan.  We are committed to having a positive impact on the health and wellness of everyone and every community we serve. We care for more than 700,000 members across New York and Vermont, and we are powered by the ideas and energy of more than 1,600 employees – providing a wide range of health benefit plan options with attentive service and flexibility normally associated with a smaller company.  Stop settling for “just a job,” and join a company where you can reach your full potential…and make a positive difference!

JOB SUMMARY:

Responsible for ASO stop loss policy administration including specific claimant identification, completion of notification forms, and claims filing to ensure MVP meets its contractual and fiduciary responsibilities. The analyst is responsible for developing and managing stop loss reports including group claimant management reports, eligibility questionnaires, and monthly aggregate reporting. This licensed position will also solicit and sell policies to stop-loss carriers on behalf of MVP ASO customers and brokers. The Analyst will manage claim submissions on stop loss policies to carriers, and verification of policy details including obtaining carrier renewals and/or contracts. Data for carrier notifications and submission tracking will be analyzed and QC’d. Serves as a liaison between the reinsurance carriers, group Account Manager on assigned book of business. Position will require collaboration with various/several internal departments as well as external carriers for client detail including but not limited to reporting data for all assigned groups. Position will interact, potentially on a daily basis, receiving multiple/ random emails or phone calls assisting to provide resolution to those communications by answering questions or providing the necessary direction regarding member inquiries. Additionally, the Stop-Loss Analyst will maintain and update the MS Access databases for monthly reporting of data or the platform in which data is reported and distributed. Generates and ensures the timely financial accuracy of the data for the monthly reports. Assists with reviewing reports to identify potential high cost claimants. Provides the reinsurance carrier with the necessary information required for claims to be reimbursed under the group reinsurance policy. Position will oversee any reinsurance program analysts in department for any required training, process guidance, direction and timely completion of work load. Performs other related tasks as needed.

 

Qualifications:

Minimum Education:

4-year college degree or equivalent amount of education and related/relevant experience required.

Minimum Experience:

NYS & VT Life Accident & Health license required or obtain with in first 90 days (II) Medical terminology experience/familiarity: ICD10, CPT, HCPCS, Medical Claims or Prescription Claims

Previous reinsurance experience a plus, and/or self-funding/TPA health insurance experience required including general knowledge of medical benefit plan options, claims process, UM process and strong communication and customer service skills.

 

Additional Information

MVP Health Care is an Affirmative Action/Equal Opportunity Employer). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency, protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

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