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, resolve carrier inquiries, and ensure compliance with internal and regulatory standards in a 100% remote environment.

Key responsibilities

• Compiles and submits stop loss claims to the carrier for reimbursement while maintaining accurate records
• Acts as a customer service role model, providing timely follow-up and escalating issues as necessary
• Performs quality assurance by monitoring trends and collaborating with teams to improve internal processes

Required qualifications

• High School Diploma or GED
• 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
• Ability to review and prepare supporting documents such as EOBs and claims extracts
• Proficient in Microsoft Office and possess strong organizational and analytical skills