Stop Loss Claims Specialist

Job Summary

A company is looking for a Stop Loss Representative to join their team.

Key Responsibilities

• Manage stop loss claims by compiling, submitting, and documenting claims for reimbursement
• Provide customer service by following up with internal and external customers and escalating issues as needed
• Perform quality assurance by monitoring trends, collaborating on process improvements, and maintaining detailed records

Required Qualifications

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