Stop Loss Coordinator

FIND YOUR FUTUREWe're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. OverviewThe Stop Loss Coordinator will be responsible for operational support functions that include client annual reporting, analytical reporting, benefit analysis, and various internal reports in accordance with each client's specific stop loss policy. The Coordinator will be responsible for maintaining goals in accuracy, productivity, and timeliness. They will respond to internal customer inquiries from departments including but not limited to Client Services, Claims Operations, Customer Service, and Sales on claim status related to stop loss policies. The Coordinator will be responsible for accurately identifying operational stop loss issues and offer sound recommendations for resolution as required. The Stop Loss Coordinator will work independently and maintain workflow with minimal supervision and demonstrate problem-solving and decision-making skills. They will coordinate efforts to control medical expenses through negotiation with nonparticipating providers, facilitation of efforts with cost containment vendors, and cross functional operational initiatives. They will contribute to research and implementation of industry best practices in cost containment and ensure appropriate reimbursement for specific negotiated care management cases. Duties will also include assisting case managers in negotiating non-participating providers/non-contracted, out of area services, the preparation of monthly savings reports by line of business, notifying reinsurance carriers of high dollar cases and ensuring proper and timely payment of such claims. Qualifications High school diploma or GED required. Associates degree preferred. Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services required. Self-funded healthcare experience preferred. Knowledge of self-funded insurance and stop loss insurance preferred. 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. Essential Accountabilities 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/re

Created: 2026-03-07