Remote Stop-Loss Claims Specialist - Aggregate Focus

Paycom - ATS; United States; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life and Disability Insurance

Paid Time Off

Tuition Reimbursement

Technology Stipend

Job summary

Allied in the United States is seeking a Stop Loss Claim Specialist to prepare and file stop loss claims for aggregate coverage. You will monitor claim status, follow up with carriers, and appeal denials while maintaining proper documentation and timely reporting.

Ideal candidates have 1-2 years of self-funded claims experience, strong Excel skills, and the ability to interpret Stop Loss contracts and SPD. Remote work is supported with a comprehensive benefits package.

Qualifications

• 1-2 years of claims experience in a self-funded environment.
• Strong knowledge of Stop Loss terminologies, concepts, and catastrophic claim handling.
• Ability to interpret Stop Loss contracts and SPD.
• Proficient with Microsoft Office Suite, especially Excel.

Responsibilities

• Compile and submit claim reports and the necessary documentation to file a stop loss claim.
• Frequently monitor the status of claims assigned and follow up with stop loss carriers.
• Audit the aggregate positions, tracking the funding balance and updated reporting monthly.
• Prepare year-end and monthly accommodation aggregate claim filings upon reconciliation.
• Appeal the denials or reductions by the stop loss carrier.

Skills

Claims experience

Stop Loss knowledge

Contract interpretation

Excel

Analytical skills

Time management

Communication skills

Education

High School diploma

Some college coursework preferred

Tools

Microsoft Office

Excel

Job description

Allied in the United States is seeking a Stop Loss Claim Specialist to prepare and file stop loss claims for aggregate coverage. You will monitor claim status, follow up with carriers, and appeal denials while maintaining proper documentation and timely reporting.

Ideal candidates have 1-2 years of self-funded claims experience, strong Excel skills, and the ability to interpret Stop Loss contracts and SPD. Remote work is supported with a comprehensive benefits package.