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We are looking for a highly organized and detail-oriented Stop Loss Coordinator to oversee and streamline the claims process for stop loss insurance. This role involves managing claims from submission to resolution, ensuring compliance with policies and timely reimbursements. The ideal candidate will collaborate with internal teams and carriers to maintain accurate documentation and provide updates on claims progress.
Job Responsibility:
Manage the complete lifecycle of stop loss claims, from submission to resolution, ensuring timely and accurate processing
Coordinate with the Finance department to reconcile reimbursements and payments effectively
Monitor pending claims submissions and promptly respond to carrier requests for additional information
Review and interpret stop loss policies to confirm compliance with reimbursement and claims requirements
Maintain thorough and organized records of claims documentation and correspondence following company procedures
Analyze claims data and address carrier denials or requests for further clarification
Provide regular updates to management regarding claim statuses, pending issues, and expected resolution timelines
Collaborate with internal teams to gather necessary information for claims processing
Perform additional duties as assigned to support the overall claims management process
Requirements:
Minimum of 2 years of experience in stop loss claims processing or a related field
Proficiency in handling insurance reimbursement and account reconciliation
Strong knowledge of stop loss policies and claims procedures
Exceptional organizational skills to maintain accurate and detailed documentation
Ability to analyze data and address carrier requests or denials effectively
Excellent communication skills for coordinating with internal teams and external carriers
Familiarity with industry-specific regulations and compliance standards
Capability to work independently and manage multiple tasks efficiently