Stop Loss Claims Specialist

Allied National, LLC; Overland Park (KS); On-site; USD 60,000 - 90,000; Full time

Job summary

Allied National, LLC seeks a Stop Loss Claims Specialist to join our team in Overland Park, KS. You will identify, track, review, and process stop-loss reimbursements on behalf of carriers within an MGU stop-loss operation.

The ideal candidate has strong knowledge of medical claims, interpretation of stop-loss contracts, and experience managing large claims in self-funded environments. This role emphasizes accuracy, audit trails, and timely processing.

Qualifications

• Must have 3+ years of experience in medical claims processing, stop-loss administration, aggregate claim review and processing, or a related self-funded environment.
• Must be able to read, interpret, and apply stop-loss contracts, policy language, and supporting plan documents.

Responsibilities

• Review and process specific and aggregate stop-loss claims in accordance with policy provisions, carrier guidelines, and internal procedures
• Interpret stop-loss contracts and supporting plan documents to determine reimbursement eligibility, required documentation, and claim disposition
• Monitor high-cost and ongoing claims for reimbursement potential and follow up on outstanding submissions or requests for additional information
• Prepare, track, and report specific and aggregate claim activity, including aggregate accommodation calculations, monthly reporting, and audit support
• Analyze claims, medical documentation, and supplemental materials to ensure timely, accurate claim handling and clear audit trails

Skills

Medical claims processing

Stop-loss knowledge

Analytical skills

Independent work

Education

High school diploma or equivalent

Associate degree in related field

Bachelor's degree in related field

Job description

Description

Allied is excited to announce that we are looking for a Stop Loss Claims Specialist to join our team! This person will be responsible for identifying, tracking, reviewing, and processing stop-loss reimbursements claims on behalf of carriers within an MGU stop-loss operation. An ideal candidate brings strong knowledge of medical claims, stop-loss policy interpretation, and large-claim management in a self-funded or TPA environment.

Duties/Responsibilities

• Review and process specific and aggregate stop-loss claims in accordance with policy provisions, carrier guidelines, and internal procedures
• Interpret stop-loss contracts and supporting plan documents to determine reimbursement eligibility, required documentation, and claim disposition
• Monitor high-cost and ongoing claims for reimbursement potential and follow up on outstanding submissions or requests for additional information
• Prepare, track, and report specific and aggregate claim activity, including aggregate accommodation calculations, monthly reporting, and audit support
• Analyze claims, medical documentation, and supplemental materials to ensure timely, accurate claim handling and clear audit trails

Requirements

• Must have a high school diploma or equivalent. Associate or Bachelors in a related field is a plus.
• Needs to have 3+ years of experience in medical claims processing, stop-loss administration, aggregate claim review and processing, large claim review, or a related self-funded environment
• Must be able to read, interpret, and apply stop-loss contracts, policy language, and supporting plan documents