Detego Health is a national Third Party Administrator (TPA) and level-funded plan sponsor offering self-funded and level-funded plan administration and reporting. We operate much like an independent accounting or law firm, providing “behind the scene” professional claims and benefit plan administration for our clients.

REQUIRED:

• Insurance Stop Loss Experience
• Claims Processing Experience
• Health Insurance Experience
• Preferred: Case Management, Finance & IT

Job Summary:

Stop-loss insurance (also known as excess insurance) is a produce that provides protection against catastrophic or unpredictable losses. It is purchased by employers who have decided to self-fund their employee benefit plans, but do not want to assume 100% of the liability for losses arising from the plans. Under a stop-loss policy, the insurance company becomes liable for losses that exceed certain limits called deductibles.

Duties:

• Review all claim submission for completeness, accuracy, and comformance to the Plan Document, SPD, and Policy
• Communicate all necessary follow-up with TPAs and other parties.
• Conform appropriate disclosure when applicable.
• Calculate and maintain reserves as needed.
• Communicate all payment or denial decisions in a clear and professional manner.
• Monitor Aggregate Accommodation activity and review aggregate claim submissions.
• In conjunction with the Claim Director, develop and enhance claim procedures to communicate to TPAs for Employer Stop Loss business (ESL).
• Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsbility.

Skills:

- Strong financial report writing skills

- Ability to analyze complex financial data

- Knowledge of regulatory reporting requirements

- Proficiency in accounting software and Microsoft Office Suite

- Excellent attention to detail and organizational skills

- Strong problem-solving and critical-thinking abilities

This position offers competitive compensation based on experience.

Job Type: Full-time

Pay: $27.00 - $32.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• No nights
• No weekends

Travel requirement:

• No travel

Ability to Relocate:

• Omaha, NE 68154: Relocate before starting work (Required)

Work Location: In person