Remote Stop-Loss Claims Specialist I

Allied Benefit Systems; Chicago (IL); Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Remote-friendly culture

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Generous Paid Time Off

Tuition Reimbursement

EAP

Job summary

Allied Benefit Systems is seeking a Stop Loss Claim Specialist to prepare and file medical stop loss claims for reimbursement with carriers. The role involves follow-ups with carriers, handling appeals of denied reimbursements, and maintaining required documentation.

The position requires 1–2 years of claims experience, proficiency with MS Excel, and strong communication and organizational skills. Remote-friendly environment with flexible setup and comprehensive benefits.

Qualifications

• 1-2 years of claims experience in a self-funded environment.
• Thorough knowledge of Stop Loss terminologies and contracts.
• Stop loss filing experience preferred

Responsibilities

• Compile and submit claim reports and documentation to file a stop loss claim.
• Monitor status of claims and follow up with stop loss carriers.
• Answer questions from carriers promptly with thorough information for reimbursements.
• Communicate with internal departments to resolve claim issues.
• Prepare initial, subsequent, and year-end claim filings upon reconciliation.
• Manage time to file advanced funding and high-dollar submissions per contracts.
• Appeal denials or reductions of reimbursements by carriers.
• Understand stop loss policy provisions and SPD documents for reimbursement support.

Skills

Claims experience

Stop Loss knowledge

Excel

Communication skills

Time management

Organizational skills

Problem solving

Relationship building

Education

High School diploma or equivalent

Some college or equivalent work experience

Tools

Microsoft Excel

Microsoft Office Suite

Job description

Allied Benefit Systems is seeking a Stop Loss Claim Specialist to prepare and file medical stop loss claims for reimbursement with carriers. The role involves follow-ups with carriers, handling appeals of denied reimbursements, and maintaining required documentation.

The position requires 1–2 years of claims experience, proficiency with MS Excel, and strong communication and organizational skills. Remote-friendly environment with flexible setup and comprehensive benefits.