Stop Loss Claims Specialist

Coordinating the tracking and submission of stop loss claims, the full-time Stop Loss Claims Specialist will manage claims documentation, customer service interactions, and quality assurance processes in a fully remote environment. Key responsibilities Compile and submit stop loss claims to carriers, ensuring accurate documentation and timely reporting Provide customer service support by following up with internal and external customers and escalating complex issues as needed Monitor quality assurance by documenting trends and collaborating with peers to improve internal processes Required qualifications High School Diploma or GED; Associate degree in a related field preferred 2-3 years of experience in medical claims administration or health insurance operations Experience with self-funded medical plans and understanding of stop loss concepts Familiarity with preparing supporting documents such as EOBs and claims extracts Prior experience working with stop loss carriers or TPAs is a plus