Risk Management Specialist: Stop-Loss Claims & Reimbursement

Relation Insurance Services; Tulsa (OK); On-site; USD 29,000 - 50,000; Full time

Benefits offered by this job

Competitive pay

Health and wellness program

401K and PTO

Job summary

Relation Insurance seeks a Risk Management Specialist to oversee stop-loss claims end-to-end for self-funded plans. You will collaborate with carriers, internal teams, and brokers to ensure accurate submissions and timely reimbursements.

The role requires handling documentation, interpreting policy language, and supporting reconciliation to maximize recoveries for employer clients. Strong attention to detail and compliance are essential.

Qualifications

• High school diploma or equivalent required; four-year degree preferred.
• Experience in health insurance, claims administration, or reimbursement fields is desirable.
• Ability to interpret policy language and follow procedures in a compliance-sensitive environment.
• Strong attention to detail with accurate documentation and timely follow-up.

Responsibilities

• Manage the stop-loss claims lifecycle from submission to final reimbursement and closure.
• Coordinate with stop-loss carriers to facilitate review and timely payments.
• Gather data from brokers, employer groups, and internal stakeholders for complete submissions.
• Review paid claims, reconciliation data, and ensure maximal recoveries under policy provisions.
• Interpret policy language and contract terms to determine eligibility and coverage.
• Ensure ongoing compliance with submission deadlines and identify process gaps.

Skills

Attention to detail

Excellent written & verbal

Communication skills

High-volume workflow handling

Compliance mindset

Microsoft Office proficiency

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

Microsoft Office

Claims systems (general)

Job description

Relation Insurance seeks a Risk Management Specialist to oversee stop-loss claims end-to-end for self-funded plans. You will collaborate with carriers, internal teams, and brokers to ensure accurate submissions and timely reimbursements.

The role requires handling documentation, interpreting policy language, and supporting reconciliation to maximize recoveries for employer clients. Strong attention to detail and compliance are essential.