Health Claims Stop Loss Specialist

TL;DR

Health Claims Stop Loss Specialist: Managing the end-to-end stop loss reimbursement process for health plans with an accent on claim eligibility assessment, documentation, and carrier coordination. Focus on ensuring accurate financial filings, tracking outstanding reimbursements, and maintaining data integrity to protect client financial outcomes.

Location: Must be based in Tempe, AZ

Salary: $21.00–$24.00 per hour

Company

hirify.global provides a personalized health platform that integrates health plan administration, wellbeing solutions, and care navigation to improve health outcomes and reduce costs.

What you will do

• Prepare and file stop loss claim submissions by assessing eligibility against policy terms.
• Create and maintain audit-ready claimant files throughout the claim lifecycle.
• Track outstanding reinsurance requests and follow up with carriers to drive resolution.
• Maintain accurate reimbursement databases for leadership reporting.
• Coordinate communication between pharmacy benefit managers and internal stakeholders.
• Escalate disputed or at-risk items to ensure timely resolution.

Requirements

• High school diploma or GED required.
• Minimum 3 years of experience in stop loss, claims, or healthcare operations.
• Proficiency in Microsoft Office, specifically Excel.
• Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes.
• Ability to interpret financial reports, legal documents, and contract terms.
• Strong mathematical and statistical reasoning skills.

Culture & Benefits

• Comprehensive medical and dental coverage through internal health solutions.
• Paid Time Off and mental health support.
• Retirement planning and financial protection benefits.
• Professional development opportunities with clear career progression.
• Mission-driven culture focused on improving health and wellbeing.