Now is the time to join us! 

Who are you?

The Director of Stop Loss and Subrogation plays a strategic role in building and managing relationships with internal departments and staff. This position requires a specialized knowledge of group health, stop loss concepts and the understanding of timely processing of grievances, appeals and provider claim disputes in compliance with all Federal and State Laws.

In this role you will wear many hats, but your knowledge will be essential in the following:  

· Understanding the differences in various stop loss policies, Paid, Incurred and Paid and their contract types/terms

· Understands Subrogation process and procedures

· Comprehension of Specific Coverage versus Aggregate Coverage

· The ability to interpret Stop Loss and Aggregate policies language

· Acts as a liaison between the Account Managers, Claims Managers, and the Stop Loss Team for possible stop loss claims, especially at plan year end groups

· Handles complex issues and denials from Stop Loss Carriers

· Communications with stop-loss carriers for requests for an extension in initial filings

· Review of timeliness for initial and supplemental stop loss filings and backlog

· Release of Over Specific, System Hold “on hold” claims

· Reach out to Account Managers for handling of groups check registers held for funding with specific members for end of group’s plan year end

· Performs related duties as requested to include report preparation, presentations, and special projects to assist in ensuring the success of the stop loss strategy

· Runs monthly Metric Audit to provide financial reporting of Claims Dollars Reimbursed & Volume of Claims Payment’s Received

· Maintains form letters and templates that are compliant with regulatory guidelines for use in responding to appeals, DOIs and BBB complaints

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

· Bachelor's Degree or equivalent experience (Health Care Administration, Health Policy, or Business Administration)

· 5 -10+ years of progressive group health coverage and stop loss and aggregate coverage

· Compliance or Technical Writing background a plus

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

· Confidence and a developed skillset in the areas of math, communication and negotiation

· Maintain knowledge of government regulations and compliance as they pertain to appeals, claims payments and generally recognized claims standards.

· Strong time management skills and self-discipline to effectively manage a large case load volume during peak production cycles

· Establish and maintain positive working relationships with all operational areas, management and staff to further the company’s mission

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $100,000 to $123,000. Note that salary may vary based on location, skills, and experience. This position is eligible for a target bonus/variable compensation as well as health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

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Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.