POSITION SUMMARY

The Stop Loss Claim Specialist is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers. Additional duties include following up with the various carriers to ensure reimbursements are received timely and in full. Further responsibilities include the appeals of denied and reduced claim reimbursements, along with retaining the appropriate documentation needed to support the reimbursement request.

ESSENTIAL FUNCTIONS

• Compile and submit claim reports and the necessary documentation to file a stop loss claim.
• Monitor the status of claims assigned and follow up with stop loss carriers.
• Answer questions and requests from stop loss carriers for additional information.
• Communicate with other internal departments to resolve claim issues.
• Appeal the denials or reduction of reimbursements by the stop loss carrier.
• Other duties as assigned.

EDUCATION

• High School diploma or equivalent required.
• Some college or equivalent work experience preferred.

EXPERIENCE AND SKILLS

• 1-2 years of experience in an administrative role required.
• Medical claims experience preferred.
• Accounting or Finance background a plus.

• Proficient with Microsoft Office Suite or related software.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.

COMPETENCIES

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

PHYSICAL DEMANDS

• This is an office environment requiring extended sitting and computer work.

WORK ENVIRONMENT

• Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.