Overview The Stop-Loss Specialist manages the full lifecycle of stop-loss claim submissions,
payment processing, audits, and carrier communication. This role ensures accuracy, timeliness,
and strong cross-department collaboration to support financial integrity and smooth plan
operations.
Responsibilities:
File stop-loss submissions within required timelines.
Process carrier payments, review denials, and initiate appeals when needed.
Complete year-end audits for renewing groups, ensuring all reports reconcile accurately.
Conduct follow-ups on outstanding submissions and maintain detailed tracking notes.
Prepare and submit aggregate claims and follow up monthly.
Review reports weekly and initiate new submissions promptly.
Perform routine operational tasks, including updating spreadsheets, running reports,
building files, and responding to carrier requests.
Coordinate with internal departments to gather required documentation.
Provide monthly reporting and participate in scheduled team meetings.
Skills:
Strong understanding of stop-loss processes, claims workflows, and carrier requirements
(preferred, but willing to train)
Excellent organizational skills with the ability to manage multiple deadlines
High attention to detail and accuracy in reporting, auditing, and documentation
Proficient in data entry, spreadsheet management, and report generation
Ability to analyze claim outcomes, identify discrepancies, and initiate appeals
Strong written and verbal communication skills for carrier and client interactions
Proactive follow-up skills with consistent tracking and documentation habits
Ability to work independently while maintaining accountability for timelines
Experience with claims systems (GBAS and VBA), tracking tools, or stop-loss platforms
(preferred)
Qualifications:
Strong sense of ownership and accountability for deadlines and follow-through
Excellent time-management skills with the ability to prioritize shifting workloads
Clear, professional communication when working with carriers, clients, and internal
teams
Problem-solving mindset with the ability to identify issues and take proactive action
High level of accuracy and attention to detail in all documentation and reporting
Collaborative attitude with a willingness to support team goals and cross-department
needs
