Health Claims Stop Loss Specialist

To support accurate and timely stop loss filings, the full-time Health Claims Stop Loss Specialist will manage claim submissions, track reimbursements, and liaise with pharmacy benefit managers while working remotely. Key responsibilities Prepare and file stop loss claim submissions by assessing eligibility and gathering necessary documents Build and maintain complete and accurate claimant files throughout the claim lifecycle Track outstanding reimbursements and coordinate communication between internal teams and stop loss carriers Required qualifications High school diploma or GED required; additional education in healthcare or business preferred Minimum 3 years of experience in stop loss, claims, or healthcare operations Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes Proficient in Microsoft Office, including Word, Excel, and Outlook Experience with claims databases or reimbursement tracking systems