What are the responsibilities and job description for the Stop Loss Claims Analyst/Risk Management Specialist for TPA Healthcare Benefits position at Cobalt Benefits Group LLC?
Description
Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Stop Loss Claims Analyst/Risk Management Specialist, you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.
Are you detail-oriented, analytical, and ready to take your career to the next level in the healthcare benefits industry? Join our dynamic team as a Stop Loss Claims Analyst/Risk Management Specialist, where you'll play a critical role in protecting our clients from large medical claims. This hybrid position offers the flexibility of working remotely two days a week after completing an initial training period. You can be based out of either our Exeter, NH or South Burlington, VT office locations.
Responsibilities:
- Track & Report: Identify and report members who meet 50% or more of the specific deductible to our excess loss vendor.
- Data Management: Collect and submit all required documentation to request reimbursement for claims that exceed the specific deductible.
- Claim Processing: Review daily funding requests, track paid claims, and manage eligible claims submissions for stop-loss and advanced funding requests.
- Communication & Coordination: Act as the liaison between the excess loss vendor and internal teams, providing necessary data and responding to vendor inquiries.
- Audit & Reporting: Assist with monthly and year-end aggregate claim submissions and support internal audits by providing necessary information.
Requirements
- Education & Experience: associate's degree or 2 years of relevant work experience.
- Proficiency in MS Office: Solid experience with Microsoft Word, Excel, and Outlook.
- Industry Knowledge: Familiarity with healthcare claims, stop-loss insurance, and medical terminology is a plus.
- Highly Organized: Able to manage multiple tasks efficiently in a fast-paced environment.
- Analytical Mindset: Strong mathematical skills are essential for tracking claims and preparing reimbursement requests.
- Attention to Detail: You'll be responsible for managing high-cost claims, so accuracy is key.
- Team Player: Ability to work collaboratively across multiple departments and communicate effectively.
- Industry Experience: A background in accounting, medical billing, or banking is helpful, as well as familiarity with medical terminology. Experience with third-party administrators (TPAs) or health insurance carriers is strongly preferred.
Benefits:
After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:
- Fantastic medical, dental, and vision insurance*
- Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
- Company provided Basic Life and AD&D
- Company paid Short-Term and Long-Term Disability**
- Flexible Spending Accounts*
- 401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)
- 10 paid holidays
- Generous paid vacation and sick time
- Annual Volunteer Paid Day
- Annual Tuition Reimbursement
- Annual Health and Wellness Reimbursement
- Lots of fun company events
Who We are:
As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue.
With over 30 years of experience and a dedicated team of more than 200 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit https://www.cobaltbenefitsgroup.com/careers/.
Benefit Waiting Period Notes:
*60 day waiting period
**90 day waiting period
Salary : $25 - $27
