Stop Loss Claims Specialist Jobs

You must be 18 years of age or older

A High School Diploma or GED Equivalent is preferred.

You should be able to resolve simple store related situations through the understanding of our store procedures.

You must possess the ability to stand for prolonged periods of time throughout the day.

You are also required to obtain a County Liquor Card and Safe Food Handlers Certificate within60 days of hire.

Maintain continued inspection of the store cleanliness and presentation including organizing, re- stocking and refreshing items as the day goes on.

You must be 18 years of age or older

A High School Diploma or GED Equivalent is preferred.

You should be able to resolve simple store related situations through the understanding of our store procedures.

You must possess the ability to stand for prolonged periods of time throughout the day.

You are also required to obtain a County Liquor Card and Safe Food Handlers Certificate within60 days of hire.

Maintain continued inspection of the store cleanliness and presentation including organizing, re- stocking and refreshing items as the day goes on.

Excellent customer service and decision-making skills

Relevant claims adjusting experience and/or construction background

An annual bonus based on individual and enterprise performance

Paid Time Off (PTO), plus:

5 days of Life Leave to take care of yourself and your family

Annual Celebration Day to celebrate what's important to you

Act as a mentor and coach, providing input to management regarding mentee performance

Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability

All the benefits listed above are subject to the terms of their individual Plans.

Demonstrate strong relationship skills with external partners and reinsurance markets

Bachelor’s degree or equivalent, relevant business experience

Mastery of product provisions, plan designs, pricing and contractual benefits

The position involves the daily management of assigned work and includes the following essential functions:

• Addressing questions and concerns from other departments, underwriting and management in a timely manner

• Ability to interact effectively with assigned staff, management, agents, insureds, and underwriters

• Meeting or exceeding monthly production requirements

• Participating in monthly meetings and trainings (on site or remotely)

• Performing Quality Control checks of reports when requested by Loss Control manager

Prefers pending or obtained certification in case management or other applicable clinical specialties.

Insures potential high risk claimants are engaged in care management protocols.

Elicits support from sales and account management, brokers, consultants and group customers to insure care management engagement with high risk members.

Works proactively with pharmacy management to insure efficient and appropriate specialty drug usage and site of service delivery.

Acts as a resource to sales and account management teams in communicating case management services interaction with stop loss management

Performs other duties as may be assigned by management.

Review pre-certification and pre-notification lists for holistic Utilization Management, especially for high dollar claimants

10+ years of experience in clinical and medical management roles

Bonus for experience working with a stop-loss carrier or working with a cross-functional team of underwriting, claims, and case management

Work with network UM/CM vendors to design and review care and case management pathways for specific claimants

Work with our Case Management teams to best assist these members

Identify opportunities for lower cost medication options including site of care and alternative benefit options

Resolves processing situations which occur on the assigned files, understanding the guidelines and providing recommended solutions to management.

Working knowledge of Microsoft Suites such as Excel, and Word and data entry systems such as AS400.

Continuing education and career certifications

Minimum three (3) years of insurance claims processing and/or mortgage servicing background experience.

Strong math and critical thinking skills.

Strong verbal and written communication and customer relationship skills.

Farmers offers a competitive salary commensurate with experience, qualifications and location.

Performs most duties on an individual basis, and work has a direct bearing on Management results.

Represents the Company from a public relations standpoint and must conduct oneself as a member of Management at all times.

For more information, review “What we offer” on https://www.farmers.com/careers/corporate/#offer

Target Starting Pay: $24.11- $34.66 based on geographical location and experience level.

Adjusts all types of claims.

We’re looking for someone who has these abilities and skills:

Ethical: Handle responsibilities with integrity and the highest standards of professionalism.

Intellectual curiosity: Willing to ask questions and explore new ideas. Eager to learn and focused on continuously improving technical skills.

Education: Bachelor's degree required, JD preferred.

Enhanced family friendly leave benefits

Signatory to the UK Women in Finance Charter