Stop-Loss Claims & Reimbursements Specialist

Gaddr; United States; On-site; USD 31,000 - 34,000; Full time

Job summary

Personify Health is seeking a Stop Loss Specialist to drive accurate filing of stop loss claim submissions and manage claimant records from eligibility through settlement. You will track reimbursements, maintain audit-ready files, and coordinate with PBMs and internal teams to ensure timely cash flows.

The role emphasizes rigorous data handling, adherence to policy terms, and collaboration across departments to protect client interests and optimize outcomes.

Qualifications

• Education: High school diploma or GED; healthcare-related education a plus.
• At least 3 years in stop loss, claims, or healthcare operations.
• Knowledge of medical terminology, CPT, HCPCS, ICD-10 codes.
• Proficient with Microsoft Office and data interpretation.

Responsibilities

• Prepare and file stop loss claim submissions within internal timelines.
• Build and maintain claimant files throughout the claim lifecycle.
• Track and recover reimbursements from stop loss carriers.
• Maintain reimbursement database for leadership reporting.
• Coordinate with PBMs and internal stakeholders on stop loss matters.
• Escalate unresolved or disputed items to supervisor promptly.

Skills

Microsoft Office proficiency

Financial analysis

Education

High school diploma or GED

Tools

Microsoft Word

Excel

Outlook

Claims databases

Reimbursement tracking systems

Job description

Personify Health is seeking a Stop Loss Specialist to drive accurate filing of stop loss claim submissions and manage claimant records from eligibility through settlement. You will track reimbursements, maintain audit-ready files, and coordinate with PBMs and internal teams to ensure timely cash flows.

The role emphasizes rigorous data handling, adherence to policy terms, and collaboration across departments to protect client interests and optimize outcomes.