Stop-Loss Claims Strategist

Relation Insurance, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 29,000 - 50,000; Full time

Benefits offered by this job

Competitive pay

Safe and healthy work environment with

Benefits program including 401K and P📎

Job summary

Relation Insurance, Inc. seeks a Risk Management Specialist to administer stop-loss claims for self-funded plans from submission to final resolution.

You will work with claims teams, account executives and carriers to maintain workflows, resolve issues and maximize eligible recoveries for employer clients. Responsibilities include collecting documentation, interpreting policy language, validating reports, and ensuring compliance with deadlines.

Qualifications

• High school diploma or equivalent.
• Four-year degree preferred.
• Minimum 1 year of experience in health insurance, claims administration or operations, or a reimbursement-related field.
• Prior experience with stop-loss insurance preferred.
• Familiarity with insurance carriers and reimbursement processes preferred.
• Basic knowledge of policy interpretation and contract language preferred.
• Demonstrated ability to manage high-volume, high-accuracy workflows, including reconciliation, documentation, and deadline-driven follow-up.
• Strong attention to detail and ability to follow written procedures in a compliance-sensitive environment.
• Ability to interpret basic policy language and follow processes accurately.
• Intermediate computer proficiency, specifically with Microsoft products and the ability to learn new systems.
• Excellent written and verbal communications skills are required.

Responsibilities

• Manages the stop-loss claims lifecycle from initial submission through final reimbursement and closure.
• Coordinates directly with stop-loss carriers to facilitate claim review and ensure timely reimbursement payments.
• Partners with internal teams, including claims and account executives, to gather data and move claims through the reimbursement process.
• Collects, reviews and manages required documentation from brokers, employer group, members and internal stakeholders.
• Reviews and validates paid claims reports, reimbursement calculations, and reconciliation data to maximize recoveries.
• Maintains organized records with detailed and accurate documentation.
• Analyzes and interprets stop-loss policy language and insurance contracts to determine eligibility and reimbursement accuracy.
• Ensures ongoing compliance with policy requirements, documentation standards, and submission deadlines.
• Leverages AI tools to analyze stop-loss policy language and contract provisions.
• Fully adopts innovative technology, including proprietary AI solutions, into the service process.
• Performs other projects, duties, and tasks as assigned.

Job description

Relation Insurance, Inc. seeks a Risk Management Specialist to administer stop-loss claims for self-funded plans from submission to final resolution.

You will work with claims teams, account executives and carriers to maintain workflows, resolve issues and maximize eligible recoveries for employer clients. Responsibilities include collecting documentation, interpreting policy language, validating reports, and ensuring compliance with deadlines.