Stop Loss Coordinator Job at Robert Half (Feasterville-Trevose)

Stop Loss Coordinator

We are partnered with a growing insurance organization on a Stop Loss Coordinato...

Location

United States , Chicago

Salary:

52000.00 - 64000.00 USD / Year

Daley and Associates

Expiration Date

Until further notice

Requirements

2+ years within health insurance, stop loss, underwriting support, or related operations
Strong organizational and communication skills
Experience working with Excel and Microsoft Office
Ability to manage multiple priorities in a fast-paced environment

Job Responsibility

Managing stop loss quote activity and proposal inboxes
Supporting underwriting workflow and quote turnaround times
Reviewing files for completeness and coordinating nurse reviews
Assisting with onboarding and sold case processing
Preparing monthly reporting and operational support materials

Fulltime

Stop Loss Auditor

A Connecticut based Medical Insurance company is seeking an experienced Stop Los...

Location

United States

Salary:

65000.00 - 75000.00 USD / Year

Daley and Associates

Expiration Date

Until further notice

Requirements

3+ years of medical stop loss insurance experience (required)
Experience auditing stop loss or first-dollar medical claims
Strong knowledge of: Plan Documents and Stop Loss policies, Reinsurance contracts, Medical terminology and coding (ICD-10, HCPCS, CPT-4)
Ability to work independently in a remote environment while collaborating with a team

Job Responsibility

Audit medical stop loss claims for assigned clients
Review and approve Plan Documents to ensure compliance
Evaluate reimbursement requests and determine claim validity
Verify claims are paid according to Plan Documents and Stop Loss policies
Confirm participant and dependent eligibility
Review high-cost claims for financial accuracy, coding accuracy, and cost containment coordination
Process claim reimbursements on behalf of carriers/reinsurers
Maintain accurate and detailed claim documentation
Meet established accuracy and turnaround time standards
Identify and recover overpaid claims through refund requests

Fulltime

Senior Stop Loss Auditor

A Connecticut based Medical Insurance company is seeking an experienced Senior S...

Location

United States

Salary:

75000.00 - 90000.00 USD / Year

Daley and Associates

Expiration Date

Until further notice

Requirements

3+ years of medical stop loss insurance experience at the Senior level (required)
Experience auditing stop loss or first-dollar medical claims
Strong knowledge of: Plan Documents and Stop Loss policies, Reinsurance contracts, Medical terminology and coding (ICD-10, HCPCS, CPT-4)
Ability to work independently in a remote environment while collaborating with a team

Job Responsibility

Lead audits of complex and high-cost medical stop loss claims for assigned clients
Interpret and apply Plan Documents and Stop Loss policy provisions
Evaluate reimbursement submissions and render claim determinations
Verify eligibility, financial accuracy, and medical coding compliance
Review claims for coordination with cost containment programs
Ensure claims are processed within established accuracy and turnaround standards
Identify and pursue recovery of overpaid claims
Maintain detailed audit documentation and reporting
Partner with TPAs, carriers, and internal teams throughout the approval process
Support cross-functional collaboration and knowledge sharing across teams

Fulltime

Stop Loss Specialist

We're seeking a detail-oriented professional who can support the coordination an...

Location

United States , Covington

Salary:

21.00 - 23.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

High school diploma or general education degree (GED) required
Minimum 3 years related experience and/or training, or equivalent combination of education and experience
Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses relative to Stop Loss preferred
Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
Computer literacy with proficiency in Windows and Microsoft Office environment (Word, Excel, Outlook)
Knowledge of insurance database systems preferred
Experience with EDOCS platform or similar documentation management systems
Detail-oriented, analytical, financially minded approach to Stop Loss coordination
Ability to read, analyze, and interpret common financial reports and legal documents
Capability to work with mathematical concepts such as probability and statistical inference

Job Responsibility

Prepare Stop Loss submissions: Analyze Stop Loss claims and applicable documents to determine filing eligibility under Excess Loss Policy while processing all submissions within established timeframes
Coordinate funding requests: Manage Advanced Funding Requests with clients and Stop Loss carriers while maintaining comprehensive database of all specific reimbursement requests
Manage documentation systems: Create initial Specific File for each claimant and file all submissions in EDOCS platform while coordinating release of Over Specific, System Hold claims
Serve as liaison: Act as connection point between PBMs and internal clients for Stop Loss claimants while maintaining professional communication with all stakeholders
Monitor reimbursements: Track all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reimbursement reports and following up with carriers
Support plan year activities: Assist with Plan Year End Closeouts while keeping immediate supervisor apprised of open or disputed items requiring attention
Maintain workflow excellence: Contribute to daily workflow with regular, punctual attendance while performing related or assigned duties as required

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Health Claims Stop Loss Specialist

We're seeking a detail-oriented professional who can support the coordination an...

Location

United States

Salary:

19.00 - 22.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

High school diploma or general education degree (GED) required
Minimum 3 years related experience and/or training, or equivalent combination of education and experience
Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses relative to Stop Loss preferred
Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
Computer literacy with proficiency in Windows and Microsoft Office environment (Word, Excel, Outlook)
Knowledge of insurance database systems preferred
Experience with EDOCS platform or similar documentation management systems
Detail-oriented, analytical, financially minded approach to Stop Loss coordination
Ability to read, analyze, and interpret common financial reports and legal documents
Capability to work with mathematical concepts such as probability and statistical inference

Job Responsibility

Prepare Stop Loss submissions: Analyze Stop Loss claims and applicable documents to determine filing eligibility under Excess Loss Policy while processing all submissions within established timeframes
Coordinate funding requests: Manage Advanced Funding Requests with clients and Stop Loss carriers while maintaining comprehensive database of all specific reimbursement requests
Manage documentation systems: Create initial Specific File for each claimant and file all submissions in EDOCS platform while coordinating release of Over Specific, System Hold claims
Serve as liaison: Act as connection point between PBMs and internal clients for Stop Loss claimants while maintaining professional communication with all stakeholders
Monitor reimbursements: Track all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reimbursement reports and following up with carriers
Support plan year activities: Assist with Plan Year End Closeouts while keeping immediate supervisor apprised of open or disputed items requiring attention
Maintain workflow excellence: Contribute to daily workflow with regular, punctual attendance while performing related or assigned duties as required

What we offer

Comprehensive medical and dental coverage through our own health solutions
Mental health support and wellness programs designed by experts who get it
Flexible work arrangements that fit your life
Retirement planning support to help you build real wealth for the future
Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths
Mentorship from industry leaders who want to see you succeed
Learning budget to invest in skills that matter to your future
Competitive base salary that rewards your success

Fulltime

New

Clinical Specialist, Quality Management I

Who We Are: Because health is personal. That's why Personify Health created the ...

Location

United States

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

Active, unrestricted Registered Nurse (RN) license required
Basic computer literacy
The ability to work on multiple screens, and proficient typing skills
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Ability to work independently and utilize written resources to problem solve
After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in: Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Excellent verbal and written communication skills for upward and downward conversations
Level I: In-depth knowledge of applicable regulations and accreditation standards (HIPAA, CMS requirements as applicable, NCQA, URAC)

Job Responsibility

Ensure compliance with state, federal, and accreditation requirements (e.g., HIPAA, CMS, NCQA, URAC, ERISA, as applicable)
Conduct internal and external audits of UM/CM/CDM processes and documentation
prepare audit files, findings, and corrective action recommendations
Identify quality and compliance risks and collaborate with cross-functional partners on mitigation and resolution
Review and support SOPs and workflows to ensure regulatory alignment and operational clarity
Support external audit readiness activities, including NCQA and URAC evidence preparation and maintenance
Develop, maintain, and deliver role-based training curriculum aligned to compliance standards, quality goals, and operational workflows
Conduct onboarding and orientation to prepare staff for assigned UM/CM/CDM functions
Deliver training using multiple modalities (virtual, self-paced, and one-on-one coaching) tailored to adult learners
Ensure training covers applicable processes such as case initiation and closure, documentation standards, high-dollar case monitoring, stop-loss notification, administrative support, customer service, and productivity expectations

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Unlimited PTO—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Production Manager

Translate the master production schedule into daily/weekly shift targets, ensuri...

Location

Egypt , Alexandria

Salary:

Not provided

Ethics HR

Expiration Date

Until further notice

Requirements

Bachelor's degree in Mechanical, Chemical, Industrial, or Materials Engineering or relevant major from a reputable university
10 - 12 years of hands-on production experience in Porcelain Tableware, Ceramic Tiles, Sanitary Ware, or Heavy Clay industries or relevant manufacturing industry
A 'hands-on' floor manager who balances technical problem-solving with strong leadership to motivate large teams of floor labor and technical staff

Job Responsibility

Translate the master production schedule into daily/weekly shift targets, ensuring optimal capacity utilization of machinery and workforce
Directly manage all sequential production departments: Mass Preparation: Slip house operations, milling, and filter pressing
Shaping/Forming: Isostatic pressing, jiggering, or casting
Drying & Glazing: Managing greenware drying cycles and glaze application lines
Firing: Maximizing loading density and maintaining continuous flow through kilns
Monitor and improve Overall Equipment Effectiveness (OEE) by minimizing micro-stops, line changeover times, and machine idle times
Ensure seamless, 24/7 operations of tunnel and shuttle kilns, as unexpected shutdowns can cause severe thermal damage to equipment and massive material loss
Partner closely with the Quality department to maintain low factory scrap rates
Monitor process parameters to instantly catch and correct mechanical causes of warping, cracking, or glaze defects
Implement production sequences that optimize gas and electricity consumption, which represent a massive percentage of porcelain production costs

Claims Review Specialist

We're seeking a detail-oriented professional who can support the coordination an...

Location

United States , Tempe

Salary:

20.00 - 30.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

High school diploma or general education degree (GED) required
Minimum 3 years related experience and/or training, or equivalent combination of education and experience
Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses relative to Stop Loss preferred
Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
Computer literacy with proficiency in Windows and Microsoft Office environment (Word, Excel, Outlook)
Knowledge of insurance database systems preferred
Experience with EDOCS platform or similar documentation management systems
Detail-oriented, analytical, financially minded approach to Stop Loss coordination
Ability to read, analyze, and interpret common financial reports and legal documents
Capability to work with mathematical concepts such as probability and statistical inference

Job Responsibility

Prepare Stop Loss submissions: Analyze Stop Loss claims and applicable documents to determine filing eligibility under Excess Loss Policy while processing all submissions within established timeframes
Coordinate funding requests: Manage Advanced Funding Requests with clients and Stop Loss carriers while maintaining comprehensive database of all specific reimbursement requests
Manage documentation systems: Create initial Specific File for each claimant and file all submissions in EDOCS platform while coordinating release of Over Specific, System Hold claims
Serve as liaison: Act as connection point between PBMs and internal clients for Stop Loss claimants while maintaining professional communication with all stakeholders
Monitor reimbursements: Track all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reimbursement reports and following up with carriers
Support plan year activities: Assist with Plan Year End Closeouts while keeping immediate supervisor apprised of open or disputed items requiring attention
Maintain workflow excellence: Contribute to daily workflow with regular, punctual attendance while performing related or assigned duties as required

What we offer

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

Fulltime

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Stop Loss Coordinator

Job Description

Job Responsibility

Requirements

What we offer

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