CareFirst Seeks two (2) Positions: Sales Consultant III- Medical Stop Loss, Group Life & Disability and Claims III- Stop Loss Adjuster

MyHealthGuide Source: CareFirst, 7/12/2021

1.  Sales Consultant III- Medical Stop Loss, Group Life & Disability

Full details and application

Job Function: Sales & Account Management
Location: Owings Mills, MD, United States
Campus: MD-Owings Mills-Owings Mills I
Status: Full-Time

This role is responsible for acquiring complex medical stop loss opportunities within the Commercial Markets Division for large and national accounts. This position represents the organization in acquisition strategy development, prospecting, network analytics, financial evaluation and negotiating with clients and brokers using consultative selling skills in order to grow new stop loss business and enhance profitability.

Essential Functions

Demonstrates mastery of sales techniques by aggressively grow new business for medical and ancillary products in the group market segment Ensure appropriate update of Sales strategy/sales activities documentation on a monthly basis. Accounts are very complex in nature.

Develop strong Broker relationships utilizing advanced strategic and consultative selling skills both in person and through electronic communication.

Provide documented formal training of assigned Brokers throughout the year including the use of virtual training technology where appropriate. Must be able to create and effectively conduct training presentations on all medical and ancillary products, as well as regulatory changes.

Management and coaching of assigned Brokers to ensure paperwork and enrollment process is followed correctly. Take appropriate action where necessary to ensure that distribution partners are following guidelines.

2.  Claims III- Stop Loss Adjuster (self-funded)

Full details and application

Job Function: Operations
Location: Baltimore, MD, United States
Campus: MD-Baltimore-Canton Crossing
Status: Full-Time

Under the direction of the Supervisor, the incumbent’s accountabilities include, but are not limited to, the following:

1. Research and analyze technical issues to ensure that methodologies are appropriate and consistent. Ensure all processing/adjusting/recovery requirements met to generate appropriate end-result. Complete the entry of new data and process/adjust transaction to the point of completion in a timely and accurate manner. Assist the adjustment unit by adjudicating complex claims and adjustments, and adjustments related to the most corporately visible and time sensitive situations such.
2. Analyze and resolve claim edits and deferrals daily. Complete the processing of these adjustment transactions in a timely and accurate manner to prevent a negative impact on corporate time lapse. Serve as the primary resource for assisting the Supervisor with training new adjusters and developing Adjusters I’s and II’s. Identify problems or trends related to adjustments performed. Initiate problem reports for corrective action. Assist the Supervisor for testing system fixes and other system projects.
3. Maintains reports and updates cases on daily basis. Gathers own productivity data daily and refers information to Supervisor. Monitors emails, voice mails, and various updates to ensure proper procedures are followed. In the absence of the Supervisor, perform as team leader assuring the unit’s goals are met.
4. Perform other duties as assigned, including providing phone support if needed. Identify problems or trends related to adjustments performed.

About CareFirst

In its 83rd year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit healthcare company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to 3.4 million individuals and employers in Maryland, the District of Columbia and Northern Virginia. In 2019, CareFirst invested $43 million to improve overall health, and increase the accessibility, affordability, safety and quality of healthcare throughout its market areas.  Visit carefirst.com.