Stop Loss Claims Specialist

Allied National, LLC • Overland Park, KS

11d

About The Position

Allied is seeking a Stop Loss Claims Specialist to identify, track, review, and process stop-loss reimbursement claims for carriers within an MGU stop-loss operation. The role requires knowledge of medical claims, stop-loss policy interpretation, and large-claim management in a self-funded or third-party administrator (TPA) environment.

Requirements

• High school diploma or equivalent.
• At least 3 years of experience in medical claims processing, stop-loss administration, aggregate claim review and processing, large claim review, or a related self-funded environment.
• Ability to read, interpret, and apply stop-loss contracts, policy language, and supporting plan documents.

Nice To Haves

• Associate or bachelor's degree in a related field.

Responsibilities

• Review and process specific and aggregate stop-loss claims according to policy provisions, carrier guidelines, and internal procedures.
• Interpret stop-loss contracts and supporting plan documents to determine reimbursement eligibility, required documentation, and claim disposition.
• Monitor high-cost and ongoing claims for reimbursement potential and follow up on outstanding submissions or requests for additional information.
• Prepare, track, and report specific and aggregate claim activity, including aggregate accommodation calculations, monthly reporting, and audit support.
• Analyze claims, medical documentation, and supplemental materials to support timely, accurate claim handling and clear audit trails.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED