Aggregate Stop Loss Specialist

Independent Medical Systems, Inc.; Idaho; On-site; USD 55,000 - 85,000; Full time

Job summary

Assured Benefits Administrators, Inc. (ABA) in the United States seeks an Aggregate Stop Loss Specialist to manage aggregate reporting for self-funded plans.

You will research claims data, file reimbursements, and coordinate with carriers to ensure accuracy and audit readiness. This role requires 3+ years as a claims examiner processing first-dollar medical claims, stop-loss insurance knowledge, and strong Excel skills in a fast-paced environment.

Qualifications

• Associate degree preferred; equivalent combination of education and experience considered.
• Intermediate level computer skills, including Word and Outlook.
• Advanced Excel required.

Responsibilities

• Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests per carrier policies.
• Research claims data to validate thresholds, accumulators, and eligibility.
• Respond to audit requests and gather documentation for accuracy before release.
• Document authorizations and denials from stop-loss carriers; track escalations and approvals.
• Maintain professional communication with internal teams, vendors, carriers, brokers, and clients.

Skills

Claims knowledge

Excel

Communication

Attention to detail

Education

Associate degree preferred

High school diploma or GED

Tools

Microsoft Word

Outlook

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

OP-Stop Loss Regular Full Time Clerical US

ABOUT US

Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we’re fully integrated with our long-term partners, who are recognized as industry leaders.

ABA is a certified “Great Place to Work”, united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence, ABA is committed to delivering connected, transparent, and innovative healthcare solutions to employers and members across the United States.

POSITION SUMMARY

The Aggregate Stop Loss Specialist manages aggregate reporting and filings for self-funded and level-funded clients. The role requires strong claims knowledge to research, reconcile, and file aggregate reimbursements and monthly accommodations accurately and on time, while coordinating across internal teams, clients, and stop-loss carriers to ensure compliance, data integrity, and audit readiness.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

• Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests in accordance with carrier policies, plan documents, and internal procedures.
• Perform detailed research using claims data to validate thresholds, accumulators, and eligibility supporting reimbursements and payments; resolve discrepancies.
• Respond promptly and thoroughly to audit requests; gather and review documentation for accuracy and appropriateness before release.
• Document authorizations and denials from stop-loss carriers; track escalations and approvals related to claim payments.
• Maintain professional communication with internal teams, vendors, carriers, brokers, and clients to progress filings and resolve issues.
• Operate independently while meeting deadlines, service levels, and compliance standards.
• Manage and track received, pended , and completed claim files with clear status visibility and audit trails.
• Assist with administrative tasks and special projects that support the stop-loss function.

Other job duties include, but are not limited to the following:

• May perform other duties as assigned.
• Associate degree preferred; equivalent combination of education and experience considered.
• Intermediate level computer skills, including Microsoft Word, and Outlook
• Advanced Excel required
• A high school diploma or GED certificate
• At least 3 years' experience as a claim’s examiner processing first dollar medical claims
• Stop loss insurance knowledge required
• Overall knowledge of the healthcare industry
• Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
• Strong communication and organizational skills
• Excellent written and verbal communication skills

OTHER DETAILS

Supervisory Responsibilities

None.

The noise level in the work environment is usually low to moderate.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.

The Company complies with employment regulations as they apply to the location of service.