Stop Loss Claims Specialist

Job Summary

Managing the tracking and submission of stop loss claims, the full-time Stop Loss Claims Specialist will compile claims for reimbursement, resolve carrier inquiries, and ensure compliance with internal and regulatory standards while working remotely.

Key responsibilities

• Compile and submit stop loss claims to the carrier for reimbursement and manage large case notifications
• Provide customer service by following up with internal and external customers and escalating complex issues as necessary
• Monitor quality assurance processes and collaborate with peers to improve internal procedures and documentation

Required qualifications

• High School Diploma or GED; Associate degree in a related field preferred
• 2-3 years of experience in medical claims administration or stop loss filings
• Experience working with self-funded medical plans and understanding stop loss concepts
• Prior experience with stop loss carriers, TPAs, or reinsurance partners
• Background in data verification, claim reconciliation, or financial review