Health Claims Stop Loss Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 all parties informed and aligned • Escalate unresolved, disputed, or at-risk items to the supervisor in a timely manner

🎯 Requirements

• High school diploma or GED required • Additional education in healthcare, business, or a related field 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 and benefits effective day one • 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 • Mission-driven culture where diverse perspectives drive real impact • Wellness programs • Other employee perks