Claims and Marketing Specialist - Remote Job at OneDigital
Are you looking to accelerate your career without having to hide your authentic self - a place where you can be you? A career that’s making a bigger impact on the world? At OneDigital, we are on a mission to help people do their best work and live their best lives. From the services we offer to the way we show up for each other each day, we are fueling dreams, achieving big goals, and embracing each other’s truest selves.
We understand that pursuing a new job is a big deal. Maybe you’re afraid you won’t fit in. Well, here’s the good news. For us, the days of “fit in to get in” are over and being different is not a barrier to getting ahead. Greatness comes in all shapes, sizes, colors, and experience levels. If you are looking for a people-first culture that is wired for growth, driven to serve, and totally committed to having your back, give us a shot. Your best life awaits.
Our Newest Opportunity:
The OneDigital Stop Loss Center of Excellence (SLCOE) will offer OneDigital offices a streamlined policy marketing and implementation process and a dedicated claims and service team that alleviates the complexities associated with third-party stop loss vendors and ensure OneDigital clients are receiving the most competitive rates in the market. In addition, the SLCOE will provide claims support, allowing for expedited claims reimbursement. The SLCOE will identify and manage a panel of select top-rated stop loss carriers that offers annually renewable contracts with best-in-class provisions.
The Stop Loss Specialist is responsible for all activity associated with stop loss claims processing and works collaboratively with the Analyst on marketing initiatives. The Specialist is responsible for obtaining claims details from carriers, reporting claims to carriers and advocating on behalf of the client throughout the entirety of a claim. The Specialist is a liaison for all communication between clients, carriers and vendors and must be able to work with different types of personalities. In addition to claims responsibility, the Specialist will also assist with the renewal and quoting process for all stop loss policies.
Essential Duties and Responsibilities (include but are not limited to):
- Report all members that exceed 50% of the specific deductible to the stop loss vendor.
- Submit eligible paid claims to the excess loss vendor.
- Submit eligible Advanced Funding requests to the excess loss vendor
- Maintain claims system of record data to track the submissions for turn-around of payment by the excess loss vendor.
- Update and maintain company databases, including D365
- Verify and post all payments received from the excess loss vendor in the claim system.
- Collect, review and prepare data needed to market for quotes
- Review stop loss proposals and renewals for accuracy
- Additional responsibilities as required
Qualifications, Skills and Requirements:
- Strong attention to detail
- Proficient communication and listening skills
- Can appropriately handle confidential and sensitive information
- Ability to prioritize multiple projects at once and thrives in a fast paced, energetic environment
- Excellent organizational skills
- Ability to manipulate data in Excel using functions and lookups
- Work experience that demonstrates strong technical and/or client service skills
- A self-starter and work independently, but also cooperatively in a close team environment
- Models and exemplifies the OneDigital Way - Service-oriented mentality who is personable, consistent, and reliable manner.
Education, Training and Experience:
- College degree, preferred.
- 1-2 years previous work experience, Third-party administrator, health insurance carrier, or medical billing experience preferred
- A working knowledge of Self-Funded plans is a plus
- Intermediate to Advanced Microsoft Excel experience, required.
- Current life and health producer license or ability to acquire within 90 days of hire (company paid), required
Thank you for your interest in joining the OneDigital team!
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