Stop Loss Claims Specialist

Imagine360 • ,

23h • $19 - $24 • Remote

About The Position

Imagine360 is seeking a Stop Loss Claims Specialist to join the team! This position coordinates the tracking, monitoring, documenting and submission of stop loss claims. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility. This is a 100% remote position.

Requirements

• High School Diploma or GED
• 2-3 years of experience in medical claims administration, stop‑loss filings, or health insurance operations
• Experience working with self‑funded medical plans and understanding of stop‑loss concepts (specific and aggregate)
• Experience reviewing or preparing supporting documents such as: EOBs, Claims extracts, Proof of payment, Eligibility files, Case management notes
• Working knowledge of computers and software including but not limited to Microsoft Office products
• Proficient mathematical, 10-key and typing skills
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
• Demonstrated ability to remain neutral and maintain confidentiality
• Strong written and oral communication skills
• Demonstrated ability to work independently, prioritize workloads multi-task and manage priorities in order to meet deadline

Nice To Haves

• Associate degree in Business Administration, Healthcare Administration, Finance, or a related field.
• 3-5 years of experience in stop-loss filings or high‑dollar medical claims.
• Prior experience working with stop‑loss carriers, TPAs, or reinsurance partners.
• Background in data verification, claim reconciliation, or financial review

Responsibilities

• Compiles and submits stop loss claims to the carrier for reimbursement.
• Enters appropriate stop loss claims into designated database.
• Identifies, researches, and resolves stop loss carrier questions.
• Facilitates advancement funding with Finance Department.
• Ensures accurate, complete, and timely reporting and documentation in alignment with internal standards, regulatory requirements, and stop‑loss carrier expectations.
• Manages large case notifications process.
• Acts as a role model in demonstrating the core values in customer service delivery.
• Provides timely and thorough follow up with internal and external customers.
• Appropriately escalates difficult issues up the chain of command.
• Recognizes, documents, and alerts appropriate supervisor of trends.
• Performs self-quality monitoring to develop and execute plans to meet established goals.
• Collaborates with peers and cross-departmentally to improve or streamline procedures.
• Develops new or improves current internal processes to improve quality.
• Maintain detailed internal records of filing dates, amounts, expected reimbursements, and carrier determinations.
• Produce regular reports on open filings, reimbursements received, and aging items.
• Assist leadership with audits, carrier reviews, and process improvement initiatives.

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start
• 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

What This Job Offers

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