CrawlJobs Logo

Stop Loss Coordinator

daleyaa.com Logo

Daley and Associates

Location Icon

Location:
United States , Chicago

Category Icon
Category:
Insurance

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

52000.00 - 64000.00 USD / Year
Save Job
Save Icon
Apply Position

Job Description:

We are partnered with a growing insurance organization on a Stop Loss Coordinator opportunity supporting their Accident & Health Underwriting team. This role is ideal for someone with experience in health insurance, underwriting support, stop loss operations, or policy administration looking to join a collaborative underwriting environment. Great opportunity to join a stable and team-oriented underwriting group with strong long-term growth potential.

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

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

Additional Information:

Job Posted:
May 17, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Icon
Daley and Associates - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Stop Loss Coordinator

Stop Loss Specialist

We're seeking a detail-oriented professional who can support the coordination an...
Location
Location
United States , Covington
Salary
Salary:
21.00 - 23.00 USD / Hour
personifyhealth.com Logo
Personify Health
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
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
Read More
Arrow Right

Health Claims Stop Loss Specialist

We're seeking a detail-oriented professional who can support the coordination an...
Location
Location
United States
Salary
Salary:
19.00 - 22.00 USD / Hour
personifyhealth.com Logo
Personify Health
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
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
Read More
Arrow Right

Claims Review Specialist

We're seeking a detail-oriented professional who can support the coordination an...
Location
Location
United States , Tempe
Salary
Salary:
20.00 - 30.00 USD / Hour
personifyhealth.com Logo
Personify Health
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
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
Read More
Arrow Right

Stop Loss Auditor

A Connecticut based Medical Insurance company is seeking an experienced Stop Los...
Location
Location
United States
Salary
Salary:
65000.00 - 75000.00 USD / Year
daleyaa.com Logo
Daley and Associates
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
Read More
Arrow Right

Stop Loss Coordinator

We are looking for a highly organized and detail-oriented Stop Loss Coordinator ...
Location
Location
United States , Feasterville-Trevose
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
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
Job Responsibility
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
What we offer
What we offer
  • medical
  • vision
  • dental
  • life and disability insurance
  • 401(k) plan
Read More
Arrow Right

Senior Stop Loss Auditor

A Connecticut based Medical Insurance company is seeking an experienced Senior S...
Location
Location
United States
Salary
Salary:
75000.00 - 90000.00 USD / Year
daleyaa.com Logo
Daley and Associates
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
Read More
Arrow Right
New

Sr. Benefits Administrator

We are seeking a highly experienced Senior Benefits Administrator to serve as th...
Location
Location
United States , Livonia
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3+ years of progressive benefits administration experience
  • Strong expertise administering medical, dental, vision, life, disability, FSA/HSA, and retirement programs
  • Minimum 1 year of experience supporting self-funded health plans, TPAs, and stop-loss administration
  • Strong understanding of COBRA, FMLA, ACA, HIPAA, ERISA, and related compliance requirements
  • Experience with Form 5500 filings, annual notices, and SPD administration
  • Experience partnering with payroll, finance, brokers, carriers, and third-party leave vendors
  • Proficiency with HRIS and benefits administration systems
  • Strong reconciliation, audit, and problem-solving skills
  • Ability to manage confidential information with professionalism and discretion
  • Exceptional attention to detail, communication, and follow-through
Job Responsibility
Job Responsibility
  • Administer all employee benefit programs including medical, dental, vision, prescription, FSA/HSA, life, disability, retirement, wellness, and voluntary benefits
  • Own day-to-day benefits operations, ensuring accurate and timely processing of enrollments, life events, terminations, and deductions
  • Manage self-funded medical plan administration including eligibility, funding coordination, claim issue resolution, stop-loss reporting, reimbursements, and TPA management
  • Conduct regular benefit audits, invoice reconciliations, and discrepancy resolution through completion
  • Support retirement plan administration including eligibility, employee changes, audit requests, and escalated issues
  • Serve as the primary escalation point for employees and vendors regarding benefits-related concerns
  • Act as the internal liaison for 3rd party leave administrators
  • Coordinate and oversee all leave activity including FMLA, ADA, state-mandated leaves, and company leaves
  • Track open leaves, manage return-to-work, and ensure compliance with all applicable regulations
  • Partner closely with employees, managers, HR, payroll, and vendors throughout the leave process
What we offer
What we offer
  • medical insurance
  • vision insurance
  • dental insurance
  • life insurance
  • disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right
New

Human Resources Associate

AlphaSights is looking for a Human Resources Associate to join our growing Human...
Location
Location
United States , New York
Salary
Salary:
85000.00 USD / Year
alphasights.com Logo
AlphaSights
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 1-3 years of experience in an HR generalist, HR Operations or Benefits Administration role
  • Bachelor’s degree, with strong academic credentials (minimum 3.3 cumulative GPA) and noteworthy extracurricular leadership
  • Direct experience supporting open enrollment processes, including employee communications, system setup, and enrollment reconciliation
  • Familiarity with self-funded health insurance plan administration, including working with TPAs, brokers, and stop-loss carriers
  • Working knowledge of benefits compliance requirements (ACA, ERISA, COBRA, HIPAA, Section 125)
  • Strong attention to detail and highly organized
  • Ability to multitask and prioritize in a fast-paced environment
  • High degree of professionalism and integrity
  • Empathy and an approachable demeanor
  • Permanent work authorization in the United States
Job Responsibility
Job Responsibility
  • Act as the primary point of contact for day-to-day HR questions from employees
  • Administer and manage employee benefits programs including self-funded health insurance, HSA, commuter benefits, 401(k), LOA, ADA claims, and COBRA: serving as the go-to resource for employee benefits questions and issue resolution
  • Support the lead who plans Open Enrollment and take an active role in communicating and executing our annual open enrollment, including system configuration, employee education sessions, and enrollment audits
  • Support the management of the company’s self-funded health insurance plan, including claims monitoring, stop-loss reporting, plan performance analysis, and coordination with TPAs and brokers
  • Prepare and maintain benefits-related reporting, including monthly utilization reports, funding analyses, and renewal data to support strategic decision-making
  • Contribute to the calculation and process of monthly benefit related inputs for payroll and reconciles vendor bills with payroll deductions
  • Assist with compliance requirements such as ACA reporting, EEO-1 filing, HSA audit and 401(k) audit
  • Work with the Talent Acquisition and Professional Development teams in the onboarding of new employees and offboarding of departing employees
  • Manage documentation processes around employee promotions, raises, and internal transfers
  • Help drive operational improvements to HR processes
What we offer
What we offer
  • Expected total compensation of $85,000
  • 17 vacation days, in addition to 10 public holidays, and business closure during winter holiday week
  • Competitive medical, dental, and vision insurance
  • 401(k) match – 4% of your total compensation matched dollar-for-dollar
  • Prime midtown office with state-of-the-art amenities
  • some WFH flexibility
  • Fulltime
Read More
Arrow Right