Stop-Loss Claims & Reimbursements Specialist

Assured Benefits Administrators; United States; On-site; USD 70,000 - 100,000; Full time

Job summary

Assured Benefits Administrators is seeking an Aggregate Stop Loss Specialist to manage aggregate reporting and filings for self-funded clients. You will research, reconcile, and file reimbursements, coordinating with internal teams, clients, and stop-loss carriers to ensure data integrity and compliance.

The role requires strong claims knowledge and the ability to maintain audit-ready processes in a fast-paced environment. A mix of education and experience is acceptable for this position.

Qualifications

• Associate degree preferred; equivalent combination of education and experience considered.
• Advanced Excel required.
• Microsoft Word and Outlook skills.
• At least 3 years' experience as a claims examiner processing first dollar medical claims.
• Stop loss insurance knowledge required.
• Healthcare industry knowledge.
• Ability to work in a fast-paced environment with multiple priorities.
• Excellent written and verbal communication skills.

Responsibilities

• Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests in accordance with carrier policies, plan documents, and internal procedures.
• Perform detailed research using claims data to validate thresholds, accumulators, and eligibility supporting reimbursements and payments; resolve discrepancies.
• Respond promptly and thoroughly to audit requests; gather and review documentation for accuracy and appropriateness before release.
• Document authorizations and denials from stop-loss carriers; track escalations and approvals related to claim payments.
• Maintain professional communication with internal teams, vendors, carriers, brokers, and clients to progress filings and resolve issues.
• Operate independently while meeting deadlines, service levels, and compliance standards.
• Manage and track received, pended, and completed claim files with clear status visibility and audit trails.
• Assist with administrative tasks and special projects that support the stop-loss function.

Skills

Strong communication

Organizational skills

Attention to detail

Education

Associate degree preferred

High school diploma or GED

Tools

Microsoft Word

Outlook

Excel (Advanced)

Job description

Assured Benefits Administrators is seeking an Aggregate Stop Loss Specialist to manage aggregate reporting and filings for self-funded clients. You will research, reconcile, and file reimbursements, coordinating with internal teams, clients, and stop-loss carriers to ensure data integrity and compliance.

The role requires strong claims knowledge and the ability to maintain audit-ready processes in a fast-paced environment. A mix of education and experience is acceptable for this position.