Stop Loss Claims Specialist

Job Summary

Working remotely in a full-time capacity, the Stop Loss Claims Specialist will manage the tracking, monitoring, documenting, and submission of stop loss claims while ensuring compliance with internal standards and regulatory requirements.

Key responsibilities:

• Compile and submit stop loss claims to carriers for reimbursement and manage large case notifications
• Provide exceptional customer service by following up with internal and external customers and escalating complex issues as needed
• Perform quality assurance by recognizing trends, conducting self-monitoring, and collaborating with peers to improve internal processes

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 understanding of stop loss concepts
• Prior experience working with stop loss carriers or TPAs
• Background in data verification or claim reconciliation