Health Claims Stop Loss Specialist

🕒 August 27

🇺🇸 United States – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• Assess claim eligibility against excess loss policy terms • Gather required documents, run reports, and submit specific claimant filings within established internal timeframes • Create and manage the initial specific file for each claimant • Maintain accurate, complete, and audit-ready claimant records throughout the claim lifecycle • Monitor reinsurance requests to confirm receipt • Generate weekly outstanding reimbursement reports • Follow up directly with stop loss carriers to drive resolution • Maintain the database of specific reimbursement requests • Coordinate communication between pharmacy benefit managers and internal stakeholders regarding stop loss claimants • Keep supervisors informed of unresolved, disputed, or at-risk items

🎯 Requirements

• High school diploma or GED required • Additional education in healthcare, business, or a related field is a plus • Minimum 3 years of related experience in stop loss, claims, or healthcare operations • Equivalent combination of education and experience considered • Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes • Proficient in Microsoft Office, including Word, Excel, and Outlook • Ability to read, analyze, and interpret financial reports, legal documents, and stop loss contract terms • Experience working with claims databases or reimbursement tracking systems • Ability to apply mathematical and statistical reasoning to financial data and reimbursement calculations

🏖️ Benefits

• Competitive base salary • Comprehensive medical and dental through our own health solutions • Unlimited PTO • Mental health support • Retirement planning • Financial protection • Professional development with clear career progression and learning budgets • Wellness programs • Other employee perks • Full benefits package starting day one