Stop Loss Claims Specialist

Bluegrass Stream; Overland Park (KS); On-site; USD 60,000 - 75,000; Full time

Job summary

Bluegrass Stream LLC in Overland Park, KS is seeking a detail‑oriented claims professional to review and process stop‑loss reimbursement claims for carriers. You will interpret contracts and plan documents to determine eligibility and perform accurate calculations, while monitoring high‑cost claims and maintaining audit trails.

You'll follow up for missing documentation, prepare claim reports, and communicate clearly with stakeholders to resolve complex claim issues.

Qualifications

• Strong understanding of stop-loss contract and plan document interpretation.
• Detail-oriented with excellent accuracy in claims processing and calculations.
• Ability to analyze high-cost claim data and identify documentation gaps.
• Good documentation, audit trail, and record-keeping practices.
• Proven capability to produce clear claim reports and communicate effectively with stakeholders.

Responsibilities

• Review and process specific and aggregate stop-loss reimbursement claims for carriers.
• Interpret stop-loss contracts and plan documents to determine claim eligibility and required calculations.
• Monitor and assess high-cost claims, ensuring appropriate handling and documentation.
• Follow up to obtain missing or incomplete documentation and resolve claim-related issues.
• Prepare claim reports and perform accurate reimbursement calculations.
• Maintain precise audit trails and ensure claim processes are well documented.

Skills

Stop-loss contract interpretation

Claims processing accuracy

High-cost claim analysis

Documentation, audit trails

Stakeholder communication

Job description

Responsibilities

• Review and process specific and aggregate stop-loss reimbursement claims for carriers.
• Interpret stop-loss contracts and plan documents to determine claim eligibility and required calculations.
• Monitor and assess high-cost claims, ensuring appropriate handling and documentation.
• Follow up to obtain missing or incomplete documentation and resolve claim-related issues.
• Prepare claim reports and perform accurate reimbursement calculations.
• Maintain precise audit trails and ensure claim processes are well documented.

Qualifications & Skills

• Strong understanding of stop-loss contract and plan document interpretation.
• Detail-oriented with excellent accuracy in claims processing and calculations.
• Ability to analyze high-cost claim data and identify documentation gaps.
• Good documentation, audit trail, and record-keeping practices.
• Proven capability to produce clear claim reports and communicate effectively with stakeholders.