Stop Loss Claims Specialist

Job Summary

Working remotely in a full-time capacity, the Stop Loss Claims Specialist will prepare and file medical stop loss claims for reimbursement, monitor claim statuses, and manage appeals for denied claims while ensuring timely and accurate submissions.

Key responsibilities

• Compile and submit claim reports along with necessary documentation for stop loss claims
• Monitor the status of assigned claims and follow up with stop loss carriers to ensure timely reimbursements
• Appeal denied or reduced claim reimbursements and maintain appropriate documentation to support requests

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
• Proficiency in Microsoft Office Suite, particularly Excel
• Experience with stop loss filing preferred; accounting or finance background is a plus