Stop Loss Claims Specialist

Job Summary

A company is looking for a Stop Loss Representative to coordinate the tracking, monitoring, documenting, and submission of stop loss claims.

Key Responsibilities

• Manage stop loss claims by compiling and submitting claims to the carrier for reimbursement and entering claims into the designated database
• Provide customer service by following up with internal and external customers and escalating complex issues as necessary
• Ensure quality assurance by monitoring trends, collaborating on process improvements, and maintaining detailed internal records

Required Qualifications

• High School Diploma or GED; Associate degree in Business Administration, Healthcare Administration, Finance, or related field preferred
• 2-3 years of experience in medical claims administration, stop loss filings, or health insurance operations
• Experience working with self-funded medical plans and understanding stop loss concepts
• 3-5 years of experience in stop loss filings or high dollar medical claims preferred
• Prior experience working with stop loss carriers, TPAs, or reinsurance partners