Health Claims Stop Loss 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 liaise with pharmacy benefit managers while working remotely.

Key responsibilities

• Prepare and file stop loss claim submissions by assessing eligibility and gathering necessary documents
• Build and maintain complete and accurate claimant files throughout the claim lifecycle
• Track outstanding reimbursements and coordinate communication between internal teams and stop loss carriers

Required qualifications

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