Stop Loss Specialist

IMS MARKETING INC • Amarillo, TX

1d • $17 - $18 • Onsite

About The Position

The Stop-Loss Specialist manages the full lifecycle of stop-loss claim submissions, payment processing, audits, and carrier communication. This role ensures accuracy, timeliness, and strong cross-department collaboration to support financial integrity and smooth plan operations.

Requirements

• Strong sense of ownership and accountability for deadlines and follow-through
• Excellent time-management skills with the ability to prioritize shifting workloads
• Clear, professional communication when working with carriers, clients, and internal teams
• Problem-solving mindset with the ability to identify issues and take proactive action
• High level of accuracy and attention to detail in all documentation and reporting
• Collaborative attitude with a willingness to support team goals and cross-department needs
• Strong understanding of stop-loss processes, claims workflows, and carrier requirements (preferred, but willing to train)
• Excellent organizational skills with the ability to manage multiple deadlines
• High attention to detail and accuracy in reporting, auditing, and documentation
• Proficient in data entry, spreadsheet management, and report generation
• Ability to analyze claim outcomes, identify discrepancies, and initiate appeals
• Strong written and verbal communication skills for carrier and client interactions
• Proactive follow-up skills with consistent tracking and documentation habits
• Ability to work independently while maintaining accountability for timelines
• Experience with claims systems (GBAS and VBA), tracking tools, or stop-loss platforms (preferred)

Responsibilities

• File stop-loss submissions within required timelines.
• Process carrier payments, review denials, and initiate appeals when needed.
• Complete year-end audits for renewing groups, ensuring all reports reconcile accurately.
• Conduct follow-ups on outstanding submissions and maintain detailed tracking notes.
• Prepare and submit aggregate claims and follow up monthly.
• Review reports weekly and initiate new submissions promptly.
• Perform routine operational tasks, including updating spreadsheets, running reports, building files, and responding to carrier requests.
• Coordinate with internal departments to gather required documentation.
• Provide monthly reporting and participate in scheduled team meetings.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed