Independent Health · 4 hours ago
Stop Loss Coordinator
Buffalo, NY (14221)
Full-time
Hybrid
Entry Level
$24/hr - $26/hr
2+ years expIndependent Health is a healthcare organization looking for a Stop Loss Coordinator to provide operational support functions including client reporting and benefit analysis. The role involves managing stop loss issues, negotiating claims, and ensuring timely claims payment while collaborating with various internal departments.
Health CareInsuranceNon Profit
No H1B
Responsibilities
Negotiate claim reimbursement based on client’s plan document and policies and procedures
Analyze problems systematically, organize information, identify underlying causes and generate solutions while recognizing the impact on stakeholders and the organization
Identify, analyze, track and interpret medical records and reimbursement
Evaluate claim potential and identify high dollar risks
Prepare and document written rationale of claim negotiation decisions based on plan specifications and the analysis of the medical records
Secure the appropriate pricing for non-participating/non-contracted provider claims to include physician, hospital, and ancillary providers for all lines of business. Pricing direction may come from UM authorization, individual negotiated provider contracts, case management authorization, benefit and policy interpretations, regulatory and UCR software products, and pricing vendors and wrap networks
Ensure timely claims payment for designated claims requiring negotiations/repricing activity
Maintain production and savings targets according to established goals and objectives
Enter administrative authorizations on the system as appropriate, to facilitate claims payments
Manage efforts for pre-payment negotiation
Work collaboratively with cross functional teams
Demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated
Designated contact person for all issues related to stop loss for assigned groups, both internally and externally to include coordination of interdepartmental process when necessary (e.g. advance funding processes, special claim handling, check runs, check pulls)
Follow-up as needed on all negotiations and stop loss filings and communicate with the client, broker and/or stop loss carrier as necessary
Prepare and submit claims for advance funding and/or reimbursement to the stop loss carrier
Research individual claim disputes and provide resolution
Responsible for internal and external customer satisfaction in the resolution of claim specific issues
Maintain record of reimbursement check disbursement and route reimbursements back to the client
Track and manage, on a timely basis, the eligibility of claims based on the clients plan document to ensure accurate reimbursement or denial of a claim
External communication with providers, as required, to secure optimal claims pricing and provide written confirmation and follow-up to support negotiated rates
Provide rationale during claim negotiation while maintaining a professional and trustworthy demeanor
Finalize claims once a negotiated price has been secured and coordinate the payment and posting of claims as per negotiated contracts
Reconcile vendor recoveries and initiate reimbursement claims
Manage the monthly stop-loss ending process to include notification to appropriate interdepartmental teams, clients and/or brokers
Track reimbursement claims and support finance for accurate payment reconciliation
Develop and produce client and stop‑loss carrier reporting, including ad hoc requests; track and report negotiated and reimbursed savings; prepare monthly cost containment and savings reports reflecting vendor recoveries, pricing, and cost containment unit activity in coordination with internal operations
Qualification
Required
High school diploma or GED required
Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services required
Ability to meet performance goals, including accuracy and productivity
Working knowledge of medical and dental benefit designs and interpretations
Excellent written, verbal, and interpersonal communication skills
Knowledge of negotiation strategies related to healthcare claims
Effective organizational and time management skills
Must be able to work independently without supervision and have experience in exercising appropriate decision making
Exhibit initiative and self-motivation, with ability to effectively solve problems as they arise
Advanced Word and Excel skills
Knowledge of formulas and formatting skills are required
Proven examples of displaying Nova's Core 4: Act with Passion, Work Together, Be Accountable, Build Trust
Preferred
Associates degree preferred
Self-funded healthcare experience preferred
Knowledge of self-funded insurance and stop loss insurance preferred
Benefits
Scorecard incentive
Full range of benefits
Generous paid time off
Company
Independent Health
As one of Western New York's first HMOs, Independent Health covers approximately 355,000 people here and across the country with more than 100 plans, services and products.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-11-18Acquired
Leadership Team
Michael W. Cropp, M.D., M.B.A.
President and CEO
Jim Dunlop Jr.
Executive Vice President and Chief Financial Officer
Recent News
vermontbiz.com
2025-11-19
2025-11-19
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