Stop Loss Submission Specialist

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.

At Gravie, you’ll have the chance to grow your career and work with some of the brightest minds in a supportive, diverse, and collaborative environment. If you’re passionate about improving the way people purchase and access healthcare, and our culture and values inspire you, we’d love to talk.

You will:

· Run 1st dollar reports to identify if any claimants have reached the Stop Loss Spec Deductible

· File and submit claims and any additional information to the RSIC Stop Loss team and submit timely 

· Identify groups in the last 30 days of their contract period and send the list to the 1st Dollar claims management team for claims to be processed within the Stop Loss contract period

· Liaison between HPA (Health Plan Administration) claims and RSIC Stop Loss Department

· Track processed claimants’ once the Stop Loss threshold is reached

· Maintain the Reinsurance Tracker in claims processing system at 1st dollar level 

· Ensure department KPIs are met through ongoing reporting tracking and analysis 

· Developing and maintaining procedures for Stop Loss Submission Specialist

· Audit all claims prior to submission 

· Maintain claims follow-ups, and the resolution process 

· Additional duties and responsibilities as assigned 

You bring:

· Willingness to learn, be actively involved and hold yourself accountable

· Excellent collaboration skills

· Reporting knowledge of Google sheets and/or Excel

· Ability to innovate on active processes and procedures 

· Experience with third party administration, self-funding, stop loss claims, excess loss claims, and/or reinsurance is preferred 

· Strong analytical skills/abilities, along with having keen critical decision-making and problem-solving skills

· Excellent verbal and written communication skills, along with sound organizational skills, and effective customer service abilities

· Ability to work effectively on a team, as well as work well independently

· Able to work in a fast-paced environment and maintain acceptable productivity, while maintaining a high level of quality

Extra credit:

· Experience with Javelina or previous Claims software

· Fueled by ambiguity and the chance to develop new processes

· Proficient in Google Office applications

Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.