Health Claims Specialist

Job Summary

To support accurate and timely stop loss filings, the full-time Health Claims Stop Loss Specialist will manage claim submissions, track reimbursements, and maintain communication between pharmacy benefit managers and internal teams.

Key responsibilities

• Prepare and file stop loss claim submissions, ensuring eligibility and compliance with policy terms
• Build and maintain accurate claimant files throughout the claim lifecycle
• Track outstanding reimbursements and coordinate resolution with stop loss carriers

Required qualifications

• High school diploma or GED required; additional education in healthcare or business is a plus
• Minimum 3 years of experience in stop loss, claims, or healthcare operations
• Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
• Proficiency in Microsoft Office, particularly Excel and Word
• Experience with claims databases or reimbursement tracking systems