Remote Stop-Loss Claims Specialist

Imagine360; United States; Remote; USD 52,000 - 78,000; Full time

Benefits offered by this job

Health plan options

Company paid premiums for disability &

life insurance

Parental Leave Policy

20 days PTO + 10 holidays

Tuition reimbursement

401k company contribution

Professional development initiatives

Diversity & inclusion initiatives

Job summary

Imagine360 is seeking a Stop Loss Representative to join our team. This remote role coordinates tracking, documenting, and submission of stop loss claims, while maintaining a comprehensive understanding of the plan documents within scope.

The position requires experience in medical claims administration and stop-loss concepts, with strong data verification and communication skills. We offer multiple health plan options, generous PTO, and professional development opportunities.

Qualifications

• Proficiency in MS Office and typing.
• Strong analytical and detail-oriented approach.
• Ability to handle confidential information.
• Experience with stop-loss or health insurance operations is preferred.

Responsibilities

• Submit stop loss claims to the carrier for reimbursement.
• Enter stop loss claims into the designated database.
• Research and resolve stop loss carrier questions.
• Coordinate advancement funding with Finance Department.
• Maintain accurate, timely reporting and documentation per standards.
• Manage large case notifications process.
• Provide timely follow-up with internal and external customers.
• Escalate unresolved issues through the proper channels.
• Assist with audits and process improvements.

Skills

MS Office

10-key typing

Analytical skills

Data verification

Confidentiality

Education

High School Diploma or GED

Associate degree in Business Administration, Healthcare Administration, Finance, or related field

Tools

Microsoft Excel

Claims database

Job description

Imagine360 is seeking a Stop Loss Representative to join our team. This remote role coordinates tracking, documenting, and submission of stop loss claims, while maintaining a comprehensive understanding of the plan documents within scope.

The position requires experience in medical claims administration and stop-loss concepts, with strong data verification and communication skills. We offer multiple health plan options, generous PTO, and professional development opportunities.