Stop Loss Claims Specialist

A company is looking for a Stop Loss Representative to coordinate the tracking, monitoring, documenting, and submission of stop loss claims. Key Responsibilities Manage stop loss claims by compiling and submitting claims to the carrier for reimbursement and entering claims into the designated database Provide customer service by following up with internal and external customers and escalating complex issues as necessary Ensure quality assurance by monitoring trends, collaborating on process improvements, and maintaining detailed internal records Required Qualifications High School Diploma or GED; Associate degree in Business Administration, Healthcare Administration, Finance, or related field preferred 2-3 years of experience in medical claims administration, stop loss filings, or health insurance operations Experience working with self-funded medical plans and understanding stop loss concepts 3-5 years of experience in stop loss filings or high dollar medical claims preferred Prior experience working with stop loss carriers, TPAs, or reinsurance partners

Created: 2026-03-05