Stop-Loss Claims Examiner I (Beverly, MA)

Beyond Risk Management, Inc.; Beverly (MA); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Beyond Health Partners, LLC, a Beyond Risk affiliate, is seeking a motivated Claims Examiner I to join our stop loss claims team in Beverly, MA. This role is ideal for individuals early in their claims career who enjoy detail-oriented work and learning the intricacies of medical stop loss insurance.

You will review claim submissions, verify documentation, and support timely reimbursements while collaborating with TPAs, providers, and internal partners.

Qualifications

• Bachelor’s degree or equivalent work experience required.
• 2+ years of claims-related experience preferred.
• Strong attention to detail and ability to review documentation accurately.
• Willingness to learn medical stop loss insurance and plan documents.

Responsibilities

• Review stop loss claims and process for multiple carrier partners.
• Verify submission completeness, eligibility, and coverage per policy.
• Audit documentation, identify missing information, and request details as needed.
• Communicate with TPAs, producers, providers, and internal teams to advance claims.
• Maintain organized claim records and monitor case reserves.

Skills

Attention to detail

Communication skills

Teamwork

Willingness to learn

Education

Bachelor’s degree or equivalent work experience

Tools

Claims management systems

Microsoft Office

Job description

Beyond Health Partners, LLC, a Beyond Risk affiliate, is seeking a motivated Claims Examiner I to join our stop loss claims team in Beverly, MA. This role is ideal for individuals early in their claims career who enjoy detail-oriented work and learning the intricacies of medical stop loss insurance.

You will review claim submissions, verify documentation, and support timely reimbursements while collaborating with TPAs, providers, and internal partners.