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Stop Loss Analyst

Primary Location: Lansing, MI
Additional Locations: MI-Lansing
Acts as a liaison and subject matter expert between our internal and external clients and the stop loss administrators. Reviews and manages stop loss claim filings. Resolves discrepancies between the amount requested and the amount reimbursed by the stop loss carrier.

Fundamental Components:
Acts as principal point of contact for stop loss administrators (*)
Review and investigate inquiries from stop loss administrators (*)
Manage and/or request retro pre-cert reviews, medical necessity inquiries, medical records & physician orders, etc.(*)
Utilize all applicable system functions and department relationships to finalize stop loss filings (*)
Perform manual processes related to mid-year takeovers, plan year end, special handling clients, stop loss policy reviews, etc.(*)
Review Actively at Work (AAW) eligibility documents prior to submission to stop loss administrator (*)
Review and resolve mismatched filings prior to submission to stop loss administrator (retention review, aggregating-specific review, etc.) (*)
Review, adjudicate and appeal as necessary mismatched stop loss reimbursements (*)
May process filings on other claim platforms (e.g. Eldorado, LuminX)
Maintaining good relationships with internal and external clients
Escalate complex issues to Stop Loss Senior Analyst or Stop Loss Management as directed(*)
Use system reporting tools to maintain and manage daily work flow (*)
May perform processes (In/Out Posting) to finalize stop loss reimbursements systematically
Manage special accommodation product as required
Back up duties to support the stop loss team (e.g. PTO, Absences, Managing Work Loads, etc.)
Other duties as assigned and determined by Stop Loss management

Background Experience:
Stop Loss experience preferred
Claims processing background preferred
Ability to work independently and maintain service standards
Technical and Analytical skills
Proficiency in oral and written communications

Additional Job Information:
Understanding of medical terminology.Strong knowledge of benefit plans, policies and procedures.Oral and written communication skills.Ability to maintain accuracy and production standards.Technical skills.Analytical skills.

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

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