Stop Loss Submission Coordinator

Aither Health, LLC; Buffalo (NY); Hybrid; USD 29,000 - 41,000; Full time

Job summary

ADP, Inc. in Buffalo area is seeking a Stop Loss Claims Operations Specialist for a hybrid role (3 days in Amherst, NY). You will prepare and submit claims, maintain records, and liaise with clients and carriers to ensure accurate reimbursements.

The role requires 2 years of stop loss/claims operations experience, strong Excel skills, and clear written and verbal communication. The position offers a competitive hourly pay and benefits in a hybrid environment.

Qualifications

• Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services.

Responsibilities

• Clearly communicate both written and verbally with confidence to internal and external customers.
• Prepare and submit initial & subsequent claims to the stop loss carrier as requested.
• Maintain record of submissions and track reimbursement of claims.
• Follow-up on stoploss filings and coordinate with clients, brokers and carriers as necessary.
• Research individual claim disputes and provide resolution.

Skills

Communication skills

Excel proficiency

Education

Relevant healthcare or finance experience

Tools

Microsoft Excel

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time NY, Buffalo, NY, US

9 days ago Requisition ID: 1004

Salary Range: $21.00 To $30.00 Hourly

Job Title

Status: Non Exempt

This is a hybrid position - 3 days a week in Amherst NY

Why this role is important:

This role is essential to ensuring the smooth flow of our stop loss operations and the confidence of our clients and carrier partners. By facilitating accurate claim submissions, building strong relationships, and collaborating across teams, you’ll help deliver the service and results that set us apart. Your contributions directly support client satisfaction and the financial integrity of our business, making you a key part of our success.

What you’ll do :

Clearly communicate both written and verbally with confidence to internal and external customers.

Work collaboratively with cross functional teams.

Prepare and submit initial & subsequent claims to the stop loss carrier as requested.

Maintain record of submissions.

Follow-up as needed on stoploss filings and communicate with the client, broker and/or stop loss carrier as necessary.

Research individual claim disputes and provide resolution.

Responsible for internal and external customer satisfaction in the resolution of claims.

Monitor and track total reimbursement dollars for clients and prepare reporting for internal and external customers.

Track reimbursement of claims and provide support for accurate payment reconciliation.

Ensure all claim payments are issued upon receipt of stoploss funding.

What you’ll bring :

Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services; self-funded healthcare experience preferred.

The ability to meet performance goals, including accuracy and productivity.

Working knowledge of medical and dental benefit designs and interpretations.

Able to express ideas clearly in writing and conversation.

Knowledge of negotiation strategies related to healthcare claims.

Effective organizational and time management skills. Must be able to work independently without supervision and have demonstrated experience in exercising appropriate decision-making.

Initiative and self-motivation, with the ability to effectively solve problems as they arise.

Ability to research individual claim disputes and provide resolution.

Strong working knowledge of Microsoft Excel, including formulas and data organization.

Ability to demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated.

Compensation Range: $21/hr - 30/hr

Physical Requirements : Prolonged period sitting at a desk and working on a computer and the ability to lift 15 pounds.

Actual starting pay within this range will be determined based on several factors, including relevant experience, healthcare or TPA industry knowledge, skills, and overall qualifications. Final compensation will also take into account internal equity and market factors.

As an Equal Opportunity / Affir...