BRMS ยท 3 months ago
Stoploss Coordinator
Folsom
Full-time
Onsite
Entry Level
2+ years expBRMS is a company focused on stop-loss insurance management, and they are seeking a Stoploss Coordinator to monitor and prepare stop-loss data and reports. The role involves dealing with clients, carriers, and various internal departments to ensure timely claims processing and reporting.
FitnessHealth CareWellness
Responsibilities
Deals with clients that hits the 50% stop loss or has Trigger Diagnosis
Main contact in dealing with carriers, including Claims Analyst and nurses
Works with all BRMS Departments including Claims, UR, Client Managers, Accounting, Customer Support, and COBRA
Works with UR department to get more information on claims/prognosis and any underlying information to check with physician on additional information
Works with UR department once notified of any upcoming diagnosis, notify carrier of pending concerns
Works with Client Managers for initial enrollment forms, additional information, etc
Receives reinsurance checks; works with accounting to release money
Works with COBRA on premiums payment, and eligibility
Enters information in the system regarding status and follow up on public spreadsheet
Sales and renewals to update issues
Complies with policy period to file claims in timely fashion
Runs weekly claims reports after the check run to research clients for 50% stop-loss or trigger diagnosis
Requests, hospital bills, police reports, as necessary for the claims filings
Run prescription reports for claim filings
Acts as another layer of claims auditing as part of the filing process
Responsible for monthly reinsurance reports for accounting
Performs other duties and responsibilities as assigned by Management
Qualification
Required
Excellent written and verbal communication skills
Strong analytical skills and problem-solving skills
Must be dependable and maintain excellent attendance
Subject-matter expert within field
Must be able to perform data entry operations quickly and accurately
Ability to grow with changing demands of the position and the company
Strong computer skills, including Word, Excel, Outlook, and Claims System organization
Must be highly proficient in ICD-9, CPT, UBO4, HCFA codes
Must be highly organized and detail oriented
Associate's degree (A. A.) or equivalent from two-year college or technical school
Two years working claims knowledge and/or training; or equivalent combination of education and experience
Ability to read, speak, and write effectively in English
Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
Ability to write routine reports, meeting notes, project documentation, and correspondence
Ability to speak effectively before customers or employees of organization
Ability to effectively address or resolve customer service issues within guidelines of the position
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
Ability to deal with problems involving several concrete variables in standardized or non-standardized situations
Company
BRMS
BRMS is a health & wellness company offering online benefit administration solutions.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Matt Schafer
Chief Executive Officer
Company data provided by crunchbase