Stop Loss Training Lead

Job Summary

Serving as the department's technical authority, the full-time Stop Loss Training Lead will manage the submission, tracking, and reconciliation of stop loss claims while conducting audits, training team members, and driving process improvements in a remote environment.

Key responsibilities

• Act as the subject matter expert on stop loss administration and reimbursement, providing guidance on complex questions
• Review stop loss contracts and carrier requirements to ensure compliance and maximize reimbursement opportunities
• Conduct regular audits of claim submissions and documentation, reporting findings to leadership and implementing corrective actions

Required qualifications

• High School Diploma or equivalent required; Associate's or Bachelor's degree preferred
• 3-5 years of experience in stop loss, self-funded health plan administration, or related healthcare required
• Advanced claims processing and reimbursement experience strongly preferred
• Experience interpreting stop loss contracts and conducting audits preferred
• Proficiency in Microsoft Excel, Word, Outlook, and reporting tools