Stop Loss Administration Specialist

Position Description Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA." This position is responsible for the day-to-day operational needs and general oversight of Avalon stop loss administration, including monitoring the effectiveness of processes. This position provides sales and service support to internal account executives, producers, and accounts, including the responsibility for administering and/or resolving all aspects of proposals, customer service, administration, and claims issues. This position is also responsible for all aspects of stop loss administration such as eligibility confirmation, filing, reviewing, and processing stop loss claims. Serves as a subject matter expert and advisor to Sales, applicable business units, and contracted vendors and/or carriers, as applicable, to ensure that corporate strategies and business objectives are being properly executed. Uses industry expertise and intelligence to enhance management decision-making, improve functional and operational performance, and strategy execution. Responsibilities and Qualifications Responsible for administration of all aspects of stop loss account business such as proposal coordination, eligibility confirmation, claims filing, reviewing and processing reimbursements, reporting, and problem resolution. Expected to meet or exceed departmental metrics for key production responsibilities. Keeps job knowledge current by participating in educational opportunities and reading professional publications. Provides excellent customer service and sales support. Responds timely and accurately to requests. Assists, supports, and leads, as applicable, in the implementation of new products, initiatives, and projects. Ensures that all operational aspects of Avalon stop loss administration are working correctly and efficiently; takes action to correct or oversee correction. Drives implementation of process improvements to existing administrative processes. This position assists management with other duties as assigned, including sales and incentive commission reporting, projects, and product/sales strategy objectives. Accomplishes new and different requests/processes. Utilizes project management experience, strong organizational skills, and ability to successfully manage multiple concurrent projects at various stages. Responsible for creating desk procedures for all routine tasks. Existing desk procedures to be reviewed and updated at least annually.

Skills:

Proficient in Microsoft Excel. Ability to work with minimal direction, with an entrepreneurial spirit, and make effective recommendations and decisions. Effectively lead cross-functional teams and/or represent department and/or product lines at cross-functional teams. Excellence in working with numbers and analytical thinking. Leverages interpersonal relationships to negotiate and influence business decisions and resolve conflicts. Possess effective tact and diplomacy skills to gain commitments from individuals and build relationships in support of stop loss product efforts. Ability to develop, prioritize, execute, coordinate, manage, and guide implementation of major projects, as well as the ability to conduct, manage, and balance multiple projects and priorities simultaneously under intense pressure. Ability to quickly gain knowledge of new business processes and issues. Strong written and verbal communication skills; ability to communicate effectively both verbally and in writing with a variety of audiences and all levels of management as well as external clients. Ability to analyze problems and issues efficiently, determine the impact in the context of the matter being evaluated and develop effective business solutions. Flexibility, adaptability, and ability to perform job assignments independently and adapt to changing work environment, workload requirements and reporting relationships.

Knowledge:

Broad knowledge of commercial health insurance. Knowledge of existing Capital Blue Cross products and processing systems to identify, develop, and implement changes for product and/or operational enhancements, new stop loss products, or process improvements, which includes the coordination and monitoring of critical tasks that must be supported and completed by other departments to ensure timely, successful implementation.

Experience:

3 years of relevant experience. Stop loss administration experience preferred. Demonstrated experience in strong analytic thinking. Experience planning, organizing, and managing major activities and initiatives.

Education and Certifications:

Associate or bachelor's degree preferred.

Work Environment:

Sales support, innovation, implementation, operations/administration, and financial environment. Must be team oriented, flexible, and have ability to adapt to change and changing priorities. Collaborative team approach in a positive environment. Goal oriented and striving for excellence. The work environment can be fast paced at times.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds. About Us We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.