Stop Loss Lead: Reimbursement Expert & Training Catalyst

Personify Health, Inc.; United States; Remote; USD 65,000 - 73,000; Full time

Benefits offered by this job

Competitive salary

Benefits from day one

Unlimited PTO

Medical and dental coverage

Mental health support

Retirement planning

Professional development

Job summary

Personify Health, Inc. is seeking a Stop Loss Lead to serve as the department's technical authority, ensuring accurate reimbursements and contract interpretation.

You will audit submissions, train the team, and drive improvements that accelerate timely reimbursements for self-funded plans. In this role, you will review contracts, manage reimbursements end-to-end, and partner with leadership on action-oriented fixes.

Qualifications

• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• 3-5 years of experience in stop loss, self-funded health plan administration, claims, or related healthcare required
• Advanced claims processing and reimbursement experience strongly preferred
• Experience interpreting stop loss contracts and plan documents preferred
• Experience conducting audits, quality reviews, or process improvement initiatives preferred
• Experience training or mentoring team members preferred
• Advanced knowledge of stop loss administration, reimbursement processes, and contract interpretation
• Working knowledge of medical terminology and CPT, HCPCS, and ICD-10 coding (preferred)
• Proficiency in Microsoft Excel, Word, Outlook, and reporting tools
• Auditing and data analysis skills, including identifying trends and building data-driven recommendations

Responsibilities

• Serve as the stop loss authority on administration, reimbursement, and contract interpretation
• Review stop loss contracts, plan documents, and carrier requirements in depth to ensure compliance and capture every reimbursement opportunity available
• Support submission, tracking, and reconciliation of stop loss claims, and manage aging items, carrier inquiries, disputes, and escalated cases through to closure
• Conduct regular reviews of claim submissions, reimbursement tracking, documentation, and correspondence to confirm accuracy and report results to leadership
• Spot recurring errors, trends, and process gaps in audit results and propose corrective action with leadership
• Onboard new Stop Loss Specialists, create and maintain training materials and SOPs, and deliver coaching sessions
• Evaluate workflows, lead process improvement initiatives, and roll out new tools and best practices, including testing system updates
• Review and help prepare monthly stop loss and reimbursement reporting and support audits

Skills

Stop loss administration

Advanced claims processing

Auditing & data analysis

Contract interpretation

Data analysis

Education

High School Diploma

Associate/Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

Outlook

Job description

Personify Health, Inc. is seeking a Stop Loss Lead to serve as the department's technical authority, ensuring accurate reimbursements and contract interpretation.

You will audit submissions, train the team, and drive improvements that accelerate timely reimbursements for self-funded plans. In this role, you will review contracts, manage reimbursements end-to-end, and partner with leadership on action-oriented fixes.