Stop Loss Training Lead: Reimbursement Expert & Coach

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

Benefits offered by this job

Unlimited PTO

Medical and dental

Professional development

Retirement planning

Mental health support

Learning budgets

Job summary

Personify Health, Inc. is seeking a Stop Loss Lead to serve as the department's technical authority on administration, reimbursement, and contract interpretation. You’ll ensure eligible reimbursements are submitted, tracked, and collected, and you’ll audit for quality to keep outcomes strong.

You’ll onboard and coach colleagues, drive process improvements, and own monthly reporting, audits, and carrier submissions, contributing to accurate stop loss operations and client satisfaction.

Qualifications

• 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
• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred

Responsibilities

• Serve as the stop loss authority: act as the department’s subject matter expert on administration, reimbursement, and contract interpretation
• Dig into contracts and carrier requirements to ensure compliance and capture every reimbursement opportunity
• Drive reimbursements to resolution: support submission, tracking, and reconciliation of stop loss claims
• Audit for quality: conduct regular reviews of claim submissions, reimbursement tracking, documentation, and correspondence
• Turn findings into fixes: spot recurring errors and propose corrective actions with leadership
• Build and coach the team: onboard new Stop Loss Specialists and deliver training materials
• Improve how we work: evaluate workflows and support process improvements
• Own reporting and audit readiness: assist with monthly stop loss and reimbursement reporting and carrier submissions
• Step in where it counts: process stop loss claims and support special projects

Skills

Stop loss administration

Auditing & data analysis

Contract interpretation

Training/mentoring

Process improvement

Education

Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

Outlook

Reporting tools

Job description

Personify Health, Inc. is seeking a Stop Loss Lead to serve as the department's technical authority on administration, reimbursement, and contract interpretation. You’ll ensure eligible reimbursements are submitted, tracked, and collected, and you’ll audit for quality to keep outcomes strong.

You’ll onboard and coach colleagues, drive process improvements, and own monthly reporting, audits, and carrier submissions, contributing to accurate stop loss operations and client satisfaction.