Stop Loss Claims Specialist I

Responsibilities

• Prepare and file medical stop loss claims for reimbursement with stop loss carriers
• Monitor claim status and follow up with carriers to ensure timely and full reimbursement
• Appeal denied or reduced claim reimbursements with appropriate documentation
• Compile and submit claim reports and necessary documentation
• Communicate with internal departments to resolve claim issues
• Manage time to file advanced funding, high dollar, and renewal claim submissions
• Interpret stop loss policy provisions and group plan documentation

Requirements

• High School diploma or equivalent
• 1 to 2 years of claims experience in a self-funded environment
• Thorough knowledge of Stop Loss terminologies and catastrophic claim handling
• Ability to interpret Stop Loss contracts and Client Summary Plan Descriptions (SPD)
• Proficiency with Microsoft Excel and Microsoft Office Suite
• Strong analytical, problem-solving, and organizational skills
• High-speed internet (100Mbps download/25Mbps upload) for remote work

Preferred Qualifications

• Some college education
• Prior stop loss filing experience
• Background in Accounting or Finance

Benefits

• Medical, Dental, and Vision insurance
• Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• Employee Assistance Program (EAP)
• Technology Stipend