Stop Loss Claims Specialist

Job Summary

Managing the preparation and filing of medical stop loss claims for reimbursement, the full-time Stop Loss Claims Specialist will work remotely to ensure timely reimbursements, handle appeals for denied claims, and maintain necessary documentation.

Key responsibilities

• Compile and submit claim reports along with required 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 accurate documentation to support claims

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
• Proficiency in Microsoft Office Suite, particularly Excel
• Experience with stop loss filing preferred