Stop Loss Specialist

Responsibilities

• Prepare and file stop loss claim submissions
• Assess claim eligibility against excess loss policy terms
• Gather required documents, run reports, and submit spec claimant filings
• Build and maintain claimant files
• Create and manage the initial specific file for each claimant
• Keep records accurate, complete, and audit-ready throughout the claim lifecycle
• Track and recover outstanding reimbursements
• Monitor all reinsurance requests to confirm receipt
• Generate weekly outstanding reimbursement reports
• Follow up directly with stop loss carriers to drive resolution
• Maintain the reimbursement database
• Keep the database of specific reimbursement requests current and accurate
• Ensure leadership and teammates have reliable data to work from
• Serve as the liaison between PBMs and internal clients
• Coordinate communication between pharmacy benefit managers and internal stakeholders
• Keep all parties informed and aligned
• Escalate open and disputed items
• Keep your supervisor informed of unresolved, disputed, or at-risk items

Qualifications

• High school diploma or GED required
• Minimum 3 years of related experience in stop loss, claims, or healthcare operations
• Proficient in Microsoft Office, including Word, Excel, and Outlook
• Experience working with claims databases or reimbursement tracking systems
• Ability to apply mathematical and statistical reasoning to financial data and reimbursement calculations

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions
• Paid Time Off—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

Compensation

This position offers a base salary range of $22.00-$25.00 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.