Stop Loss Claims Specialist I

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Prepare and submit medical stop loss claims for reimbursement to stop loss carriers for individual stop loss (specific) coverage.

• Gather and send claim reports along with necessary supporting documents.

• Track the status of assigned claims and follow up with stop loss carriers.

• Respond promptly and comprehensively to inquiries and requests for additional information from carriers.

• Collaborate with internal departments to address claim-related issues.

• Prepare initial, subsequent, and year-end claim filings after reconciling claim activities.

• Oversee advanced funding, high-dollar, and renewal claim submissions in accordance with contract requirements and departmental metrics.

• Appeal denied or reduced reimbursement claims.

• Understand and implement stop loss policy provisions and group plan documentation.

• Adapt to new concepts and systems effectively.

• Perform other duties as assigned.

⛳️ Requirements

• High School diploma or equivalent is required.

• 1 to 2 years of claims experience in a self-funded environment.

• Comprehensive knowledge of stop loss terminologies, concepts, and the handling of catastrophic claims.

• Ability to interpret stop loss contracts and Client Summary Plan Descriptions (SPD).

• Proficient in Microsoft Office Suite, particularly Microsoft Excel.

• Strong analytical and problem-solving abilities.

• Excellent verbal and written communication skills.

• High organizational skills and exceptional attention to detail.

• Outstanding time management skills with a proven track record of meeting deadlines.

• Ability to cultivate and maintain positive relationships with team members, internal departments, brokers, reinsurance carriers, and clients.

• Access to cable broadband or fiber optic internet service with a minimum of 100Mbps download/25Mbps upload speed.

🏝️ Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life and Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• Employee Assistance Program (EAP)

• Technology Stipend

• Fully remote work

• Flexible work-from-home arrangement