Stop Loss Claims Specialist

Imagine360 • ,

6d • $40,000 - $60,000 • Remote

About The Position

Imagine360 is seeking a Stop Loss Representative to coordinate the tracking, monitoring, documenting, and submission of stop loss claims. The role maintains a comprehensive understanding of the plan documents within its scope and works with stop-loss carriers, internal teams, and customers to support accurate, timely claims administration. This position is 100% remote.

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 specific and aggregate stop-loss concepts.
• Working knowledge of computers and software, including Microsoft Office products.
• Proficient mathematical, 10-key, and typing skills.
• Organizational, problem-solving, analytical, and detail-oriented skills.
• Ability to remain neutral and maintain confidentiality.
• Strong written and oral communication skills.
• Ability to work independently, prioritize workloads, multitask, and manage priorities to meet deadlines.

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, third-party administrators (TPAs), or reinsurance partners.
• Background in data verification, claim reconciliation, or financial review.
• Experience reviewing or preparing supporting documents such as EOBs, claims extracts, proof of payment, eligibility files, and case management notes.

Responsibilities

• Compile and submit stop loss claims to carriers for reimbursement.
• Enter appropriate stop loss claims into the designated database.
• Identify, research, and resolve stop loss carrier questions.
• Facilitate advancement funding with the Finance Department.
• Ensure accurate, complete, and timely reporting and documentation in alignment with internal standards, regulatory requirements, and carrier expectations.
• Manage the large case notifications process.
• Demonstrate the company's core values through customer service delivery.
• Provide timely and thorough follow-up with internal and external customers.
• Escalate complex or unresolved issues through the established chain of command.
• Recognize and document trends and alert the appropriate supervisor.
• Perform self-quality monitoring and develop and execute plans to meet established goals.
• Collaborate with peers and other departments to improve or streamline procedures.
• Develop new or improve current internal processes to improve quality.
• Maintain detailed 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 of PTO to start and 10 paid holidays.
• Tuition reimbursement.
• 401(k) company contribution.
• Professional development initiatives and 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