Stop Loss Coordinator

Wellnet Enerji; Of; On-site; TRY 2,934,000 - 3,667,000; Full time

Job summary

Wellnet Enerji is seeking a Stop-Loss Coordinator to manage end-to-end stop-loss claims, coordinate with carriers, and support financial reconciliation. The role requires careful claims handling, timely reporting, and collaboration with internal teams to mitigate risk.

Candidates should have at least 2 years of claims experience, especially with self-insured health plans, and strong Excel/Office skills. This is an on-site position located in Turkey, Trabzon, Of, with a focus on accuracy and

Qualifications

• Minimum of 2 years of claims experience.
• Experience with administering self-insured health plans.

Responsibilities

• Submit stoploss claims for high-cost claims and plans to carriers.
• Track reimbursement claims and support finance for accurate payment reconciliation.
• Manage monthly stop loss ending process and notify interdepartmental teams, clients or brokers.
• Prepare and submit claims for advance funding or reimbursement to the stop loss carrier.
• Research claim disputes and provide resolution.
• Interact with large case management and providers to secure patient prognosis and treatment plans.
• Discuss opportunities with Account Managers to avert risk.
• Oversee end-to-end stop loss claims process for timely and accurate processing.
• Review reimbursements and coordinate with Finance for payment reconciliation.
• Monitor pending submissions and respond to carrier requests for information.
• Analyze stop loss policies to ensure understanding of reimbursement requirements by Carrier.
• Maintain organized documentation of all stop loss claims.
• Analyze claims data and Carrier denials/requests for further information.
• Provide regular updates to Management regarding claim status and timelines.
• Coordinate with internal teams when information is needed.
• Other duties as assigned.

Skills

Stop loss knowledge

Organizational skills

Professional accountability

Excel

Communication skills

Core values alignment

Tools

Microsoft Excel

Microsoft Office

Job description

The Stop-Loss Coordinator is responsible for submitting stoploss claims for high-cost claims and plans to the various carriers.

Duties/Responsibilities

• Track reimbursement claims and support finance for accurate payment reconciliation.
• Manage the monthly stop loss ending process to include notification to appropriate interdepartmental teams, clients and/or brokers.
• Monitor and track total reimbursement dollars for clients and prepare reporting for internal and external customers.
• Prepare and submit claims for advance funding and/or reimbursement to the stop loss carrier.
• Research individual claim disputes and provide resolution.
• Interact with large case management and providers to secure patient prognosis and treatment plans.
• Interact with Account Managers to discuss opportunities to avert risk.
• Manage stop loss claims process: responsible for the entire stop loss claims process, from initial submission to final resolution, to ensure timely and accurate processing.
• Review reimbursements and coordinate with the Finance team for accurate payment reconciliation.
• Monitor pending submissions of stoploss claims and respond timely to carrier requests for additional information.
• Review and analyze stop loss policies to ensure understanding of the claims and reimbursement requirements by Carrier.
• Maintain documentation: Keep detailed and organized records of all stop loss claims, including supporting documentation and correspondence in accordance with Company policies and procedures.
• Analyze claims data and Carrier denials/requests for further information.
• Provide regular updates to Management regarding claim status, pending issues, and resolution timelines.
• Coordinate with internal teams when information is needed.
• Other duties as assigned.

Required Skills/Abilities

• Knowledge of stop loss insurance.
• Strong organizational skills.
• Strong sense of professionalism and personal accountability.
• Working knowledge of Microsoft Office, particularly Excel.
• Strong communication skills.
• Alignment with our core values of optimism, respect, intelligence, adaptability, building long-term relationships.

Education And Experience

• Minimum of 2 years of claims experience.
• Experience with administering self-insured health plans.

Physical Requirements

Prolonged periods of sitting at a desk and working on a computer.

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