Health Claims Stop Loss Specialist

Location: Remote, United States

Salary: $22.65–$25.00 per hour, depending on location, skills, and experience.

Company

hirify.global provides a personalized health platform combining health plan administration, wellbeing solutions, and care navigation for employers, health plans, and health systems.

What you will do

• Assess stop loss claim eligibility against excess loss policy terms, gather documentation, run reports, and file specific claimant submissions.
• Create and maintain accurate, complete, and audit-ready claimant files throughout the claim lifecycle.
• Track reinsurance requests, generate weekly outstanding reimbursement reports, and follow up with stop loss carriers.
• Maintain the database of specific reimbursement requests and ensure reliable reporting for leadership and colleagues.
• Coordinate communication between pharmacy benefit managers and internal stakeholders regarding stop loss claimants.
• Escalate unresolved, disputed, or at-risk items to the supervisor.

Requirements

• High school diploma or GED required; additional education in healthcare, business, or a related field is a plus.
• At least 3 years of related experience in stop loss, claims, or healthcare operations.
• Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes.
• Proficiency in Microsoft Office, including Word, Excel, and Outlook.
• Ability to interpret financial reports, legal documents, and stop loss contract terms.
• Experience with claims databases or reimbursement tracking systems, plus mathematical and statistical reasoning for reimbursement calculations.

Culture & Benefits

• Full benefits package effective from day one.
• Comprehensive medical and dental coverage through hirify.global solutions.
• Unlimited paid time off.
• Mental health support, retirement planning, and financial protection.
• Professional development, career progression, and learning budgets.
• Mission-driven, inclusive culture focused on improving health outcomes.