Stop Loss Claims Specialist

Job Summary

Working fully remote, the full-time Stop Loss Claims Specialist will manage the preparation and filing of medical stop loss claims for reimbursement, follow up with carriers to ensure timely payments, and handle appeals for denied claims.

Key responsibilities

• Compile and submit claim reports along with necessary documentation for stop loss claims
• Monitor claim statuses and communicate with stop loss carriers to resolve issues and provide additional information as needed
• Audit aggregate positions and prepare year-end and monthly accommodation aggregate claim filings

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 catastrophic claim handling
• Proficient with Microsoft Office Suite, especially Excel
• Experience with stop loss filing preferred