Stop Loss Claims Specialist

Job Summary

Working remotely on a full-time basis, the Stop Loss Claims Specialist will prepare and file medical stop loss claims for reimbursement, follow up with carriers to ensure timely payments, and manage appeals for denied claims.

Key responsibilities

• Compile and submit claim reports and necessary documentation for stop loss claims
• Monitor the status of claims and follow up with stop loss carriers as needed
• Prepare initial, subsequent, and year-end claim filings and manage appeals for denied reimbursements

Required qualifications

• High School diploma or equivalent required; some college or equivalent work experience preferred
• 1 to 2 years of claims experience in a self-funded environment
• Thorough knowledge of stop loss terminologies and concepts
• Proficient with Microsoft Office Suite, especially Excel
• Ability to interpret stop loss contracts and Client Summary Plan Descriptions (SPD)