Stop Loss Claims Manager, Avant

We are looking to add a Stop Loss Claims Manager to join our Avant team in Kansas City, MO. Candidates thrive in our environment when they harness their collaborative mindset, strong interpersonal communication skills, and a love of learning.

The Stop Loss Claims Manager at Avant will be responsible for Claims oversight of TPAs and insurance carriers. Acts as the Avant advocate and intermediary/liaison between TPA, broker, and our clients. Assists in management oversight of claims operations and department.

Responsibilities:

• Acts as member and agency partner liaison.
• Participates in member claim reviews.
• Conducts TPA satisfaction surveys.
• Conducts monthly claim and reimbursement reporting on inforce customers.
• Performs annual year-end stop loss claim reimbursement audits for clients.
• Logs running record of service issues and follows through to completion.
• Participates in new group calls with TPA, ASO and Carriers, as applicable.
• Ensures special handling instructions are developed.
• Assists with annual review of stop loss carrier RFIs and responses.
• Works with TPA, ASO and Carriers on opportunities for improvement as identified on audits and surveys.
• Regular follow-up with groups as issues are identified
• Participates in event education meetings and calls.
• Participates in open claim reviews as needed by consultant or client.
• Assists with mid-year claims stewardship for consulting team and the client.

Team Duties:

• Develops and maintains positive working relationship with consulting partners, stop loss team partners, and carrier partners
• Shares claims related issues with Sr. Risk Consultant, Operations Manager, and Director of Stop Loss Services.
• Supports Avant structure and culture.

Knowledge, Skills and Abilities:

• Working knowledge of self-funded medical insurance and the ability to apply that knowledge in the performance of job duties.
• Working experience in standard and complex stop loss claim reimbursements
• Excellent communication skills and the ability to apply these skills in either verbal or written form when interacting with various clients, company personnel and team members.
• Ability to work effectively both independently as well as in a team environment to attain team and company goals.
• Excellent organizational skills and the ability to manage multiple tasks/duties simultaneously.
• Working knowledge of various software packages such as, word, excel, and PowerPoint.
• Ability to perform simple to complex mathematical calculations.
• Ability and willingness to participate in internal and external educational opportunities to enhance knowledge of current insurance topics or relevant system improvements.
• Ability to keep current on industry trends and develop relationships with contacts within the industry.
• Ability to work daily and extended hours as necessary.
• Ability to assist in other work-related duties as necessary.
• Ability to travel as needed.
• Capable of exercising discretion in confidential matters and use independent judgment.
• Must be knowledgeable of and comply with HMA' s Client Privacy Policy, HIPAA regulations and E&O procedures and policies.

Qualifications:

• Education: Minimum of high school diploma or equivalent. Some college or college degree preferred.
• Experience: Minimum 5 years' experience with managing medical and prescription drug claims with an emphasis in providing exceptional customer/client service. Experience with medical stop loss claims insurance preferred.

Benefits:  In addition to core benefits like health, dental and vision, also enjoy benefits such as:

• Paid Parental Leave and supportive New Parent Benefits — We know being a working parent is hard, and we want to support our employees in this journey!
• Company paid continuing Education & Tuition Reimbursement — We support those who want to develop and grow.
• 401k Profit Sharing — Each year, Holmes Murphy makes a lump sum contribution to every full-time employee’s 401k. This means, even if you’re not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for.
• Flexible work arrangements and schedules — We truly want to know what works for you as we look to support your unique and full potential.
• Generous time off practices in addition to paid holidays — Yes, we actually encourage employees to use their time off, and they do. After all, you can’t be at