If you speak fluent stop loss and like making sure every dollar is accounted for, this role fits you. As a Stop Loss Claims Specialist I, you will handle aggregate stop loss claim filings, track reimbursements, and fight for the correct amounts so clients are protected.
About Allied Benefit Systems
Allied Benefit Systems is a national healthcare benefits administrator that partners with employers to design and manage flexible, self funded health plans. The company focuses on smarter plan design, cost control, and responsive service that supports both clients and members. In this claims focused role, you will help keep high cost risk under control and reimbursements flowing.
Schedule
- Full time, fully remote position
- Standard business hours (specific schedule may vary by team)
- Remote friendly culture that emphasizes communication, accuracy, and accountability
- Requires reliable cable or fiber internet with at least 100 Mbps download and 25 Mbps upload speeds
What You’ll Do
- Compile and submit aggregate stop loss claim reports and required documentation to carriers
- Frequently monitor the status of assigned claims and follow up with stop loss carriers to ensure timely reimbursement
- Respond to carrier questions and requests for additional information with clear, complete support for claim reimbursement
- Communicate with internal departments to resolve claim issues and gather missing data
- Manage timelines for aggregate accommodation, level funded, and final claim submissions in line with contract requirements
- Appeal denied or reduced stop loss reimbursements and provide supporting documentation
- Audit aggregate positions, track funding balances, and maintain updated monthly reporting
- Prepare monthly accommodation and year end aggregate claim filings after reconciling claim activity
- Interpret stop loss policy provisions and group plan documents to support reimbursement requests
- Adapt to new systems, tools, and concepts as processes evolve
- Perform other duties as assigned to support stop loss operations
What You Need
- High school diploma or equivalent required; some college or equivalent work experience preferred
- One to two years of claims experience in a self funded environment
- Thorough knowledge of stop loss terminology, concepts, and catastrophic claim handling
- Ability to interpret stop loss contracts and client Summary Plan Descriptions
- Stop loss filing experience preferred
- Accounting or finance background is a plus
- Proficiency with Microsoft Office, especially Excel
- Strong analytical and problem solving skills
- Excellent verbal and written communication skills
- High level of organization with superior attention to detail
- Proven time management skills with the ability to meet deadlines
- Ability to build and maintain positive working relationships with internal teams, brokers, carriers, and clients
Benefits
- Competitive hourly pay range of 23.00 to 24.00 dollars, based on experience and qualifications
- Comprehensive Total Rewards package
- Medical, Dental, and Vision insurance
- Life and Disability insurance
- Generous Paid Time Off
- Tuition Reimbursement
- Employee Assistance Program (EAP)
- Technology stipend to support your remote work setup
If you are ready to grow your stop loss career in a fully remote role where your precision really matters, this is a strong next step.
Secure your spot while this opening is still on the table.
Happy Hunting,
~Two Chicks…