Supervisor Stop Loss

We exist for workers and their employers -- who are the backbone of our economy.  That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Summary of role:

Under the guidance of the Stop Loss Manager, The Stop Loss Supervisor will be responsible for overseeing and ensuring the completion for an end to end stop loss administration policy for Centivo’s self-funded clients. This includes but is not limited to specific claimant identification, completion of notification forms, reporting on high-cost claimants and clinical reports to the stop loss carrier, and claims filing to ensure Centivo meets its contractual and administrative responsibilities.

The Stop Loss Supervisor will work with various internal departments (including Client Success, Implementation, Claims, Member Care, IT, Clinical and Sales) and external PBMs. The Stop Loss Supervisor will also be the main point of contact for first level review of any issues, reporting concerns, as well working with other TPA’s in the industry, brokers, consultants, and various vendors to assist obtaining the necessary information for the stop loss management team to provide accurate policy management to Centivo’s clients

Responsibilities Include:

• Responsible for overseeing the stop loss management team as it completes the end-to-end stop loss claim processes and procedures, ensuring all carrier requests are filed accurately and reimbursed timely on behalf of our clients.

• Own user acceptance testing for stop loss system upgrades and enhancements, ensuring existing functionality is preserved and new capabilities meet operational requirements.

• Work cross functionally with Stop Loss Coordinators, and all key stakeholders to ensure information and timely decisions are being made for the benefit of our client and organization.

• Work with the Stop Loss Manager to adjust processes, identify and source tools, manage staffing needs (new positions and training), and collaborate with internal teams as necessary for items requiring escalation.

• Maintain a process for identifying potential specific claimants within each client’s utilization data including collaboration with other key departments and monitor specific claimants in a timely fashion

• Manage specific and aggregate claim submission processes, acting as liaison between Centivo and its stop loss carrier partners:

  • Ensuring new carriers have Non-Disclosure Agreements in place before sharing any client data

  • Providing stop loss carrier with necessary information required for claim reimbursement consideration and appeal submissions.

  • Requesting changes to stop-loss policy and/or client SPD as needed to ensure seamless coverage

  • Participating in internal workgroups and task force(s) as needed to successfully implement stop loss administration

• Analyze stop-loss policies against the quote, application, and plan document for accuracy and agreement.

• Participate actively in team and department meetings on stop loss administration process and client/product implementation planning as it may relate to stop loss management

• Ensure stop loss industry knowledge is current, bringing forward ideas and recommendations to ensure Centivo has a competitive position in the marketplace

• Training new hires and teaching the necessary workflows and processes established, and creating and maintaining documentation outlining current state policies and procedures

• Performs other miscellaneous projects, assignments, and duties as assigned by management

Team Leadership:

• Monitoring and managing the team’s assignments, including resource balancing. (Please note this is a working supervisor position where the candidate will work hand-in-hand with their team members to complete the required work.)

• Developing policies, processes and procedures to further improve the department’s services

• Defining staffing ratios and further define roles and responsibilities with the department

• Lead the management of any new functionality and workflows to improve efficiency and automate current manual processes

• Ensure knowledge transfer and training is delivered, retained and reinforced

Qualifications:

Required Skills and Abilities:

• Strong leadership and team management skills

• Demonstrated abilities with process development and improvement as well as change management

• Excellent oral and written communications; an ability to present information in a way that establishes rapport, persuades others, gains understanding.

  • Ability to anticipate the oncoming workload, identify barriers, and ensure all required work is completed timely

  • Advanced knowledge of Microsoft Office products (Excel, PowerPoint, Word)

  • Strong customer service, organizational and time management skills

  • Demonstrated ability to meet performance goals, including accuracy and productivity

• Ability to access, operate, and maintain various software applications

• Ability to work independently with minimal supervision

• Demonstrated commitment to Centivo’s mission and values

Education and Experience:

• 5 years of experience in stop loss policy management and/or financial claims analytics required

• 3 years experience leading and delegating tasks to multiple direct reports

• Bachelor’s degree required

• Stop Loss policy and administrative management and marketing experience required, specifically with self-funded insurance

• Knowledge of the stop loss claims/submission and stop loss carrier reporting needs

Preferred Qualifications:

• El Dorado/Javelina experience, Health Rules Payer (HRP)

• Ringmaster Smart-LinQ Experience

Work Location

• Preferred location Buffalo

• Eligible remote

Leadership Skills & Behaviors:

● Strategic Thinking – Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward.

● Business Acumen – A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function.

● Systems/Analytical Thinking – Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually – very powerful when accompanied by ability to communicate & clarify tactically.

● Flexibility/Working through Ambiguity – Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps.

● Communicate – Managers discuss the company’s vision and strategies, the department’s direction and goals, and in times of crisis, what we know and don’t know to make sure team members know what they need to know.

● Clarify – As managers, it’s up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding.

● Coach – Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development.

● Connect – Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network.

● Customize – As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them.

Centivo Values:

● Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.

● Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.

● Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.

Who we are:

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.