Stop Loss Data Specialist

POSITION SUMMARY

The Stop Loss Data Specialist is responsible for auditing and tracking stop loss claim filings, reimbursements, and cash advance claims to ensure the department is running in an efficient and thorough manner. The Analyst also works closely with Stop Loss Claim Specialist on administrative, organizational, and auditing functions.

ESSENTIAL FUNCTIONS

• Perform monthly audits to ensure all stop loss claims have been filed and all reimbursements have been received.
• Update and manage the stop loss tracking and specific logs to monitor the current status of members over the specific deductible.
• Review and accurately record stop loss reimbursements. 
• Gather and prepare the data required to file Rx stop loss claims.
• Request and track Actively at Work forms from Clients
• Manage the cash advance process. This includes determining which claims to pull for cash advance and mailing out the appropriate cash advance checks when reimbursements are received.
• Other duties as assigned

EDUCATION

• High School diploma or equivalent required.
• Some college or equivalent work experience preferred.

EXPERIENCE & SKILLS

• 1-2 years of experience in an office environment required.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Suite or related software.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to function well in a high-paced and at times stressful environment.
• Medical claims experience preferred
• Accounting or finance background a plus
• Experience working with a TPA or other insurance company a plus

COMPETENCIES

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

PHYSICAL DEMANDS

• This is an office environment requiring extended sitting and computer work.
   

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.