Put your eye for detail and claims experience to work handling high dollar stop loss reimbursements from home. This fully remote Stop Loss Claims Specialist role is ideal if you enjoy deep claims investigation, Excel work, and owning files from submission through reimbursement.
About Allied Benefit Systems
Allied Benefit Systems partners with employers nationwide to design and administer self funded group health plans. They help clients control healthcare costs while supporting member wellbeing, backed by strong internal operations, data, and service teams. Allied’s remote friendly culture allows you to thrive from home while contributing to meaningful work in the health benefits space.
Schedule
- Full time role
- Fully remote within the United States
- Standard weekday business hours
- Requires reliable high speed internet via cable or fiber (minimum 100 Mbps download / 25 Mbps upload)
What You’ll Do
- Compile, prepare, and submit stop loss claim reports and supporting documentation to carriers for aggregate coverage
- Monitor the status of assigned claims and follow up regularly with stop loss carriers to ensure timely and full reimbursements
- Respond to carrier requests for additional information with clear, accurate, and thorough documentation
- Communicate with internal departments to resolve claim issues and gather needed data
- Manage timelines to file aggregate accommodation, level funded, and final claim submissions in line with contract requirements
- Audit aggregate positions, track funding balances, and prepare updated monthly reports
- Prepare monthly and year end aggregate accommodation claim filings after reconciling claim activity
- Appeal denials or reductions in reimbursements, providing documentation and rationale to support the claim
- Interpret stop loss policy provisions and group plan documents to support reimbursement requests
- Handle additional claims and stop loss related tasks as assigned
What You Need
- High school diploma or equivalent required; some college or equivalent work experience preferred
- One to two years of medical claims experience in a self funded environment
- Solid understanding of stop loss terminology, concepts, and catastrophic claim handling
- Ability to read and interpret stop loss contracts and Summary Plan Descriptions
- Proficiency with Microsoft Office, especially Excel
- Strong analytical and problem solving skills with a focus on accuracy
- Excellent written and verbal communication skills
- Strong organizational skills, attention to detail, and proven ability to meet deadlines
- Ability to build and maintain positive working relationships with internal teams, brokers, carriers, and clients
Benefits
- Pay range: 23 to 24 dollars per hour
- Medical, dental, and vision insurance
- Life and disability coverage
- Generous paid time off
- Tuition reimbursement
- Employee Assistance Program
- Technology stipend to support your remote work setup
- Fully remote work environment with tools and support to stay productive at home
This kind of stop loss role does not linger long when they find someone who can balance precision, follow up, and carrier communication, so do not sit on it if you fit the profile.
If you want a remote claims role where your accuracy directly protects client dollars, this is a strong next move.
Happy Hunting,
~Two Chicks…