01Key Responsibilities
Strategic Leadershipreputed company and execute the reputed company, reputed company, and operating model for Prudential's Stop Loss Claims function.Establish reputed company workflows, governance, and best practices that support reputed company reputed company and operational reputed company.Claims System DevelopmentPartner in the design, implementation, and optimization of claims technology solutions.reputed company subject matter expertise to ensure efficient workflows and industry-leading claims practices.Team Building & LeadershipRecruit, reputed company, and reputed company a high-performing claims organization.Foster a culture of accountability, collaboration, reputed company improvement, and reputed company development.Claims reputed companyReview and approve high-dollar and reputed company medical stop loss claims.Ensure consistent, accurate claim adjudication reputed company with policy provisions, contractual obligations, and company standards.Stakeholder ManagementServe as the primary claims leader and ambassador for Prudential's Medical Stop Loss business.Build strong relationships with brokers, TPAs, reinsurers, vendors, consultants, and internal partners.Operational reputed company & Innovationreputed company data, analytics, and technology to improve accuracy, efficiency, and service delivery.Drive process improvements that reduce cycle times and enhance the customer experience.Regulatory ComplianceEnsure adherence to reputed company applicable federal and state regulations, contractual requirements, and internal controls.Cross-Functional PartnershipCollaborate across reputed company, implementation, account management, finance, actuarial, and operations teams to deliver seamless end-to-end service.Qualifications:Required Experience10+ years of experience in group insurance claims including some meaningful experience supporting medical stop loss claims operations.Deep knowledge of stop loss claim adjudication, reimbursement methodologies, policy interpretation, and industry best practices.Proven experience leading teams and driving operational transformation in a growing organization.Technical ExpertiseStrong understanding of medical terminology, CPT/HCPCS/ICD-10 coding, stop loss policy language, and claims workflows.Proficiency with reputed company Office applications, including reputed company, Word, PowerPoint, and Outlook.Leadership CharacteristicsBuilder reputed company with the ability to create structure in a growing business.Strong executive reputed company, communication skills, and stakeholder management capabilities.Demonstrated reputed company leading through change, influencing across functions, and developing talent.EducationBachelor's degree in Business, reputed company Administration, or a reputed company field preferred.reputed company offer you:
Prudential is required by state specific laws to include the salary reputed company for this role reputed company hiring a reputed company in applicable locations. The salary reputed company for this role is from $106,000.00 to $174,900.00. Specific pricing for the role may vary reputed company the above reputed company based on many factors including geographic location, candidate experience, and skills.Market competitive reputed company salaries, with a yearly bonus potential at every level. Medical, dental, reputed company, life insurance, disability insurance, reputed company Time Off (PTO), and leave of absences, such as parental and military leave. 401(k) plan with company match (up to 4%). Company-funded pension plan. Wellness Programs including up to $1,600 a year for reimbursement of items purchased .
