Stop Loss Claims Specialist

Job Summary

Coordinating the tracking and submission of stop loss claims, the full-time Stop Loss Claims Specialist will manage claims documentation, customer service interactions, and quality assurance processes in a fully remote environment.

Key responsibilities

• Compile and submit stop loss claims to carriers, ensuring accurate documentation and timely reporting
• Provide customer service support by following up with internal and external customers and escalating complex issues as needed
• Monitor quality assurance by documenting trends 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
• Familiarity with preparing supporting documents such as EOBs and claims extracts
• Prior experience working with stop loss carriers or TPAs is a plus