Stop Loss Training Specialist

Job Summary

Serving as the department's technical authority, the full-time Stop Loss Training Specialist will manage the submission, tracking, and reconciliation of stop loss claims while providing training and support to the team, ensuring compliance and optimizing reimbursement processes.

Key responsibilities

• Act as the subject matter expert on stop loss administration, reimbursement, and contract interpretation
• Review stop loss contracts and carrier requirements to ensure compliance and maximize reimbursement opportunities
• Conduct audits of claim submissions and reimbursement tracking, reporting results and performance metrics to leadership

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