Stop Loss Specialist Job at Personify Health (Covington)

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

Client Insurance Specialist

The Client Insurance Specialist is responsible for supporting new business reven...

Location

United States of America , Virtual

Salary:

160000.00 - 180000.00 USD / Year

Alight Solutions

Expiration Date

Until further notice

Requirements

Active health/life insurance license (preferred)
5+ years selling licensed insurance products (voluntary, supplemental, stop-loss, specialty, or related)
Demonstrated success expanding revenue within existing accounts
Strong understanding of benefits ecosystems and partner-based solutions
Executive presence and comfort in C-suite conversations

Job Responsibility

Engage with the Alight Partner/Carrier Network to identify prospects and build pipeline
Partner with Account Management to build strategic growth plans per client
Own the end-to-end sales cycle for specified products — discovery, proposal, partner collaboration, negotiation, and close
Maintain accurate pipeline forecasting and Salesforce hygiene
Engage HR, Benefits, Finance, Procurement, and executive sponsors
Translate product value into financial, clinical, and employee experience outcomes
Address regulatory and compliance considerations confidently

What we offer

A variety of health coverage options
Wellbeing and support programs
Retirement
Vacation and sick leave
Maternity, paternity & adoption leave
Continuing education and training
Several voluntary benefit options

Fulltime

Clinical Specialist, Quality Management and Training

The Clinical Compliance & Quality Specialist is responsible for ensuring regulat...

Location

United States

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

In-depth knowledge of state and federal regulations, including HIPAA, CMS, NCQA, and URAC
Ability to interpret and apply evidence-based guidelines and accreditation standards to clinical operations
Skilled in conducting internal and external audits of clinical programs
Proficient in case file preparation, SOP review, and audit mark-up
Capable of producing detailed audit reports and recommending corrective actions
Excellent analytical thinking and problem-solving abilities
Able to identify compliance risks and propose mitigation strategies
Uses written resources independently to resolve issues
Exceptional attention to detail in reviewing clinical documentation and audit trails
Maintains accurate records and ensures data integrity

Job Responsibility

Ensure compliance with state, federal, and accreditation standards, including ERISA, NCQA, URAC, and HIPAA
Conduct internal and external audits of clinical programs, prepare detailed reports, participate in case file preparation and mark-up for audits
Monitor clinical trial activities to ensure protocol adherence and regulatory alignment
Identify and manage risks related to clinical quality and compliance, review and approve Standard Operating Procedures (SOPs), and collaborate with cross-functional teams to resolve quality issues and implement improvements
Train clinical staff on regulatory requirements, quality standards, and department objectives
Develop and maintain evidence-based training materials and software tools, and deliver training in various modalities (classroom, virtual, self-learning, and one-on-one) to adult learners with different levels of experience
Training topics include case identification and creation, stop loss notification, administrative support, monitoring high-dollar cases, case closure, documentation, customer service excellence, and productivity expectations
Track and report training activities and employee progress, updating department leadership on staff who are not meeting expectations
Participate in quality audit programs and conduct monthly sample quality analysis audits to identify gaps and training opportunities
Support corrective action plans as directed by management and provide comprehensive follow-up

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, 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

Treasury Funding and Investment Trader

Join us at Barclays and become a member of the Treasury Funding and Investment (...

Location

Singapore , Singapore

Salary:

Not provided

Barclays

Expiration Date

Until further notice

Requirements

Development and implementation of trading strategies that align with the bank's risk appetite, investment objectives, and market conditions
Execution of trades on behalf of the bank, or proprietary trading desks, while adhering to the bank's trading strategies and risk parameters
Maintenance of accurate and timely trading records, prepare daily and monthly trading reports
Monitoring and analysis of global financial markets, economic indicators, news, and geopolitical events to identify trading opportunities and assess market risks
Management and monitoring of the risk associated with the trading portfolio, including setting and maintaining stop-loss limits and ensuring compliance with regulatory and internal risk management guidelines
Raise unsecured funding in the International Money Market
Execution of Structural Hedges for hedging IRRBB
Contribute or set strategy, drive requirements and make recommendations for change
Plan resources, budgets, and policies
manage and maintain policies/ processes

Job Responsibility

Managing the firm’s liquidity, funding and optimize our balance sheet across various currencies during Asia hours
Managing some Asia entities’ funding and liquidity profile, under the internal and regulatory control framework
Constantly assess market risk of our book and executing trades such as money market, repo, FX spot, FX swap and interest rate swaps with counterparties
Leading some of the regional projects from TFI perspective on supporting franchise growth for us in Asia
Engage with senior stakeholders across Asia businesses and contribute to both Asia and Global Treasury initiatives
To buy and sell financial instruments, such as bonds, stocks, and derivatives, to generate revenue for the bank by the analysis of market conditions, execution of trades, and management of risk

What we offer

Hybrid working
Structured approach to hybrid working with fixed ‘anchor’ days
Supportive and inclusive culture and environment
Office designed to optimise the well-being of colleagues
Integrated live-work-play development with shops, restaurants, gyms and an alfresco dining area
Convenient commute options, excellent views, and access to a range of amenities
Utilising cutting-edge technology to deploy eco-friendly facilities like a eco-farm to cultivate fresh produce in our office
Richly diverse, wholly inclusive environment

Fulltime

New

Talent Acquisition Director - Refreshment Services

The Talent Acquisition Director - Refreshment Services will lead a team of recru...

Location

United States , Philadelphia

Salary:

Not provided

Aramark

Expiration Date

Until further notice

Requirements

Bachelor's degree required
Minimum of 7 - 10 years of recruiting / talent acquisition experience with proven results in a large, full-life cycle recruiting environment
Minimum of 3 years’ experience managing and developing a recruiting / talent acquisition team
Developed a strategic road map for Talent Acquisition—designing a strategy, setting, and achieving goals, building a team, driving process improvement, and increasing internal client satisfaction
Managed recruiting budget, including allocation of resources and funding
Leadership and influence skills
ability to effectively communicate & network at both executive and operational levels
Understanding of recruiting environments, competitive landscape, and emerging trends
Experience acquiring talent in a geographically distributed field organization
Analytical skills and detail orientation

Job Responsibility

Team Leadership: Provide strategic and operational leadership for Talent Acquisition team and act as a strong role model, motivating for growth while driving a high level of performance
Coach and develop the Talent Acquisition team to ensure it has the right skills, insights, resources, and tools to meet its objectives and serve as talent advisors to the business
Develop and implement innovative candidate sourcing strategies that include networking on and offline, identifying viable passive candidates, leveraging colleague referrals, attracting a diverse range of candidates, participating in recruiting events, and utilizing social media tools and resources
Champion consistency and a strong client and customer service orientation to ensure seamless candidate experience and support for hiring managers.
Build Strong Relationships with Business Stakeholders: Develop strong partnerships with Field HR Directors to understand current talent needs and forecast for anticipated needs
proactively identify strategies to address
Meet regularly with Operational leaders to understand challenges and create tailored recruiting solutions to ensure businesses are supported
Analyze and deliver functional metrics and insights to communicate progress toward goals, identify challenged areas and develop action plans
Supports Talent Acquisition Strategy & Initiatives: Partner closely with HR leadership, fellow TA Directors and Centralized TA teams to develop and implement talent acquisition strategic initiatives.
Develop and execute business specific recruiting strategies in partnership with the business and key stakeholders in Talent Acquisition

Fulltime

New

Institutional Credit Management Product Developer - Artificial Intelligence

The Product Manager will join our mission to transform how Citi manages Wholesal...

Location

India , Mumbai

Salary:

Not provided

Citi

Expiration Date

Until further notice

Requirements

Bachelor’s degree in business / equivalent or technology related field
6-10 years of relevant experience
Expert knowledge in various software development methodologies, and project management concepts (e.g., requirements creation, feature identification, and user story writing)
Knowledge about Generative AI and Traditional AI. Key features, strong and weak points of these technologies and Experience with their implementation in existing processes.
Ability to independently lead projects through strategy, design and implementation phases and being accountable for the direct financial impact of the initiatives
Ability to present various Projects and Product to senior leadership in understandable and capturing way
Basic knowledge of programming in Python is advantage
Familiarity in a front office, middle office, or operational capacity supporting the credit lifecycle execution or related transformation efforts in wholesale lending
Demonstrated ability to translate end user needs into tangible work products that technology engineers can move forward to develop (e.g. Process Flows, Requirements, Design Artifacts, Screen Mockups, etc.)
Track record of working across multiple stakeholders and collaborating with various technology partners

Job Responsibility

Partner with various ICM colleagues and risk managers to develop origination and credit monitoring strategies for managing credit risk in a timely, accurate and complete manner.
Utilize modern Emerging technologies for simplification, automation, quality control leading to improvement in Efficiency of internal processes and systems.
Launch and manage new Products, Projects and Initiatives utilizing Emerging technologies and ensure both technical and governance deliveries of these efforts.
Effectively navigate from the strategic to the requirement level, enabling the design team to confidently execute designs informed by user needs
Lead a set of products working groups to maintain outcome-based roadmaps and sequencing, review progress towards OKRs, and track risk dependencies and issues.
Conduct design workshops that enable collaboration and conceptual solutions, while serving diverse personas
Leverage journey-based design strategies to drive an overall product design process and validate prototypes into production, including visual design and content strategy.
Drive digital transformation by re-engineering operational business processes, focusing on optimizing target state processes and end to end workflow orchestration with technology empowerment.
Follows market, industry, and client trends to own field and adapts them for application Citi’s products and solutions platforms.

What we offer

Citi provides programs and services for your physical and mental well-being including access to telehealth options, health advocates, confidential counseling and more.
Citi provides access to an array of learning and development resources to help broaden and deepen your skills and knowledge as your career progresses.
We offer our employees resources and tools to volunteer in the communities in which they live and work.

Fulltime

New

F&B Reservations and Experience Coordinator

Ladies and Gentlemen who embody the spirit of Nekajui, a Ritz‑Carlton Reserve, s...

Location

Costa Rica , Papagayo

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

Previous experience (1–2 years) in luxury hospitality, fine dining restaurants, guest experience coordination, or reservations management
Experience managing culinary or in‑residence dining experiences, including private chef services or bespoke events
Prior use of OpenTable or other advanced reservation platforms, ideally in a high‑end or luxury environment
Full professional proficiency in English and Spanish, both spoken and written
Strong proficiency in Opera, GXP, Microsoft 365, and digital communication platforms
Basic skills in design or visual‑creation tools (e.g., Canva, Adobe Illustrator, or light photo editing)
Familiarity with luxury hospitality standards, Forbes service principles, and personalized guest experience methodologies
Demonstrated ability to deliver anticipatory, personalized, and emotionally engaging service
Strong cultural awareness and the ability to interact gracefully with high‑profile guests
High level of poise, emotional intelligence, and discretion

Job Responsibility

Serve as the primary point of contact for all restaurant reservations and Food & Beverage inquiries
Coordinate and confirm all dining reservations
Manage and orchestrate all in‑residence culinary experiences
Ensure clear, real‑time communication with Restaurants, Culinary, IVD, Guest Experience, Pre‑Arrival, and Residences Services
Identify and anticipate guest preferences, allergies, and special needs
Provide elegant and timely follow‑up on celebrations, dietary needs, custom menus, or private Residence experiences
Ensure all outgoing information is accurate, updated, and consistent
Maintain continuous communication with Guest Experience and Pre‑Arrival teams
Lead the use, accuracy, and optimization of OpenTable
Identify enhancement opportunities to elevate the guest experience and contribute to revenue

Fulltime

New

Physical Therapist Per Diem

Dynamic inpatient, acute care opportunity at New Mexico’s only Level 1 trauma ce...

Location

United States , Albuquerque

Salary:

51.59 USD / Hour

UNM Hospitals

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Related Discipline
CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
NM Physical Therapist License or Temporary License

Job Responsibility

Organize and deliver medically-prescribed physical therapy to restore function and prevent disability
Evaluate patient to determine treatment goals
Consult with medical staff on patient care
Educate patient in use of specialized equipment, posture control, and therapeutic procedures
Instruct caregivers on prescribed physical therapy regimen
Adapt therapy techniques to meet patient needs
Conduct training for medical, nursing and ancillary personnel
Supervise and instruct Physical Therapy students and volunteers
Document all patient care activities
process patient billing

What we offer

Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials
Strong mentorship program for new grads

Stop Loss Specialist

Personify Health

Location:
United States , Covington

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 21, 2026

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Location:United States , Covington

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Job Description:

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Additional Information:

Job Posted:March 21, 2026

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