Health Claims Stop Loss Specialist

Personify Health

9d•$19 - $22

About The Position

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future. The Stop Loss Specialist, tracks, monitors, and documents, stop loss claims submissions. Provides additional information to the carrier as needed and tracks the receipt of reimbursements from carriers and the transitions of reimbursement funds. This position maintains a comprehensive understanding of the plan document(s). Their scope of responsibility includes underlying stop loss contracts and terms. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

High school diploma or general education degree (GED) required.
2+ years experience with claims/call center health insurance environment.
Must be computer literate and knowledgeable in Windows and Microsoft Office environment, including Word, Excel and Outlook.
Strong written and verbal communication skills.
Proficient in Word, Excel, and outlook.
Ability to organize, prioritize, and multitask in a fast-paced/deadline driven environment.
Demonstrate ability to work independently with excellent judgment.
A detail-oriented, analytical, financially minded approach.
Capacity to think creatively and strategically.

Nice To Haves

Knowledge of medical terminology, CPT, HCPCS and ICD-10 codes a plus.
Experience in self-funded plan administrations a plus.
Claims processing experience or medical background a plus.

Responsibilities

Research, review and handle carrier requests for claims submission timely.
Follow stop loss contracts, procedures and guidelines.
Monthly reconciliation of groups.
Maintain, track, and post claim reimbursements.
Review individual stop loss contracts.
Review and send weekly innovative notices to carrier.
Special monthly review and preparation of stop loss reports to include RX.
Special monthly review and preparation of outstanding stop loss reimbursement report.
Submit appeals to stop loss carriers as needed.
Provide outstanding customer service to internal and external clients/brokers.
Completes other projects as assigned.
Ability to read and understand contracts - Reinsurance contracts and Summary Plan Descriptions.
Ability to meet assigned deadlines.

Benefits

Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life, not the other way around
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable
Competitive base salary that rewards your success
PTO policy because rest and recharge time is non-negotiable
Benefits effective day one—because you shouldn’t have to wait to be taken care of