Bind Benefits
  • - Operations
  • Minneapolis, MN, USA
  • Full Time

Bind is a health technology and services company founded in 2016 and headquartered in Minneapolis, MN with satellite offices in New York and San Francisco. Bind is health insurance for the way we live now. Unlike traditional health insurance that charges you for services you may never need or want, Bind is on demand: pay for what you need, not what you don't, and adjust your coverage when those needs change. Health coverage that's flexible, clear, and intuitive.

We are creative, collaborative, and a little bit fiery. The Bind team is comprised of like-minded individuals passionate about healthcare, and our cause is the collective act of rewiring it. We embrace new ideas. We're more wheel than cog. More spark than smoke. And we are playful and venturesome in our daily mission to render real and refreshing solutions to health insurance that works better for us all.

Senior Claim Examiner-Stop Loss Specialist

Summary
Bind is actively seeking a highly skilled, motivated, and experienced claims examiner with focused experience in the area of stop loss for our newly created role. As a Senior claim examiner, we will look for your experience and expertise to help keep our service levels and accuracy extremely high. We'll also look for your ideas on how to constantly evolve our claims processes. The Stop Loss Specialist portion of this job has you responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers. Additional duties include following up with the various carriers to ensure reimbursements are received timely and in full. Further responsibilities include the appeals of denied and reduced claim reimbursements, along with retaining the appropriate documentation needed to support the reimbursement request. Focus, enthusiasm, and a dedication to excellence are all personal characteristics highly valued in the Bind organization.

Responsibilities

  • Compile and submit claim reports and the necessary documentation to file a stop loss claim
  • Monitor the status of claims assigned and follow up with stop loss carriers
  • Answer questions and requests from stop loss carriers for additional information
  • Communicate with other internal departments to resolve claim issues
  • Appeal the denials or reduction of reimbursements by the stop loss carrier
  • Responsible for assisting with overall department functions and workflow at all levels
  • Claims research and review
  • Generate reports
  • Identifying potential high dollar risks
  • Comply with all carrier reporting requirements
  • Review of UR/CM reporting
  • Assist with processing reinsurance claim filings, 50% notices and claim audits
  • High level contact with stop loss carriers, case management vendors
  • Ability to report to the office
  • Monitor Claims TAT (Turn Around Times) against compliance standards
  • Monitor various reports; (i.e. Compliance, Held, etc.)
  • Inform claims team of any changes to Provider and Health Plan contracts
  • Review examiner error disputes
  • Review monthly production and accuracy reports
  • Answer questions from the claims team
  • Conduct training classes when needed for team
  • Oversight of claims projects
  • Report information to the claim manager and director regarding claims TAT, EDI issues, daily report issues, compliance related issues, staffing issues
  • Function as a liaison to Business and IT teams to align technical solutions with business needs
  • Assist in handling escalated service issue
  • Participate in the implementation and prioritization of claim operational strategies, policies, workflow processes and standards and ensure effective utilization of them

Requirements

  • Bachelor's degree preferred
  • A minimum of five years' experience processing first dollar medical claims
  • Significant knowledge of Stop Loss Industry including Stop Loss Claims, Stop Loss Policy Models and Policy Terms
  • Demonstrated ability to work as part of a cohesive team
  • Strong written and verbal communication skills
  • Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
  • Overall knowledge of health care industry
  • Proficiency using the Microsoft Office suite of products
  • Proven leadership skills – role model, motivator
  • Quick decision maker
  • Experience evaluating, revising and maintaining production, turnaround time and accuracy goals
  • Experience in automating and/or re-engineering manual claim processes
  • Excellent project management skills, with ability to manage multiple priorities with tight deadlines, and demonstrated strong problem-solving skills and attention to detail
  • Experience working as a liaison between operational departments and/or technical team
  • Ability to identify key opportunities for action in an innovating environment that includes ambiguity and change
  • Knowledge and experience in a healthcare environment with HIPAA requirements

Bind is committed to providing equal employment opportunities. All qualified applicants and employees will be considered for employment and advancement without regard to race, color, religion, national origin, sex, disability, age, marital status, sexual orientation, veteran status, genetic information, or any other status protected by applicable law.

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