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Senior Manager, Medical Stop Loss Claims/Reinsurance

Company: Symetra
Location: Bellevue
Posted on: January 12, 2021

Job Description:

Symetra has an excellent opportunity to join our Benefits division as a Stop Loss Claims Senior Manager!About the roleThe Stop Loss Claims Senior Manager will establish operational strategy for the Benefits Division Stop-Loss Claims department in support of the business unit's priorities, drive execution of critical initiatives and achieve targeted outcomes, ensure compliance with the Affordable Care Act and other regulatory and company standards, maintain strong risk management subject area and quality assurance metrics in the claims review process, and utilize continuous improvement management initiatives to deliver results and maintain high-performing team culture. What you will do* Lead a team of approximately 8-10 Stop-Loss professionals, and all aspects of quality controls, workflows and processes to ensure timely and accurate payment of Stop-Loss claims* Build and maintain a positive relationship with internal and external customers, including other business divisions Create a team environment of employee engagement designed to improve empowerment, accountability and outstanding customer service.* Handle the department budget to ensure cost-effective claims management and oversee department administrative matters* Be responsible for the review settlement of certain large, critical claims. Collaborate with team members, peers, the VP of claims, the legal and compliance departments to settle certain complex claims. Oversee responses to insurance department inquiries, consumer complaints, etc. Research, document and communicate issues to senior management appropriately for resolution and/or prevention* Prepare and distribute Stop-Loss claims metrics reports. Partner and collaborate with appropriate parties in facilitating system and workflow enhancements and development, as well as defining and prioritizing systems needs in relationship to business and users' needs.* Act as primary Stop-Loss claims department liaison for internal and external audits. Update, maintain and communicate documented workflow updates for the Stop-Loss claims team, to include Internal Audit Services, SOXBOX, etc.What we offer youWe don't take a "one-size-fits-all" approach when it comes to our employees. Our programs are designed to make your life better-both at work and at home.* Flexible work program and telecommute arrangements* Wellness program offering employees a variety of resources crafted to assist you in reaching and maintaining your optimum health* Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%* Paid time away including vacation and sick time, flex days and ten paid holidays* Give back to your community and double your impact through our company matching * Want more details? Check out our Symetra Benefits Overview opens a pdf fileWho you are* Bachelors Degree in Business Administration, Health Management, or other relevant insurance/business field required* 5 to 7 years of Stop-Loss claims management experience and catastrophic claims management experience, including people management (experience in managing a team remotely is a plus)* Financial and claim audit background; Stop-loss, Third Party Administrator and/or Reinsurance claims management experience. Health Insurance Industry designations* Proven track record of developing strategy for large organizations, partnering with lines of business to support their priorities, and a strong background in successful execution and continuous improvements (lean, efficiencies specialist). Managing, developing and outsourcing relationships.* Outstanding customer service, verbal/written communication, decision-making, problem solving, training and employee development, forecast and budgeting, and leadership skills; excellent influencing and interpersonal skills* In-depth understanding of the "self-funded insurance industry", the Employee Retirement Income Security Act of 1974 (ERISA) and the Affordable Care Act ("ACA")* Technology savvy; proficiency in tolls such as, Power BI and MS Access, is a plusWe empower inclusionAt Symetra, we embrace and celebrate diverse experiences, identities and perspectives, because lifting each other up fuels thought and creates a stronger, more innovative company. Learn more here.In a complex industry, we strive for clarity. Symetra is a dynamic and growing financial services company with 60 years of experience and customers nationwide. In our daily work delivering retirement, employee benefits, and life insurance products, we're guided by the principles of VALUE, TRANSPARENCY AND SUSTAINABILITY. That means we provide products and services people need at a competitive price, we communicate clearly and honestly so people understand what they're getting, and we build products that stand the test of time. We work hard and do what's right for our customers, communities and employees. Join our team and share in our success as we work toward becoming the next national player in our industry.For more information about our careers visit

Keywords: Symetra, Bellevue , Senior Manager, Medical Stop Loss Claims/Reinsurance, Executive , Bellevue, Washington

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