Stop Loss Submission Coordinator
Status: Non Exempt
This is a hybrid position - 3 days a week in Amherst NY
Why this role is important:
This role is essential to ensuring the smooth flow of our stop loss operations and the confidence of our clients and carrier partners. By facilitating accurate claim submissions, building strong relationships, and collaborating across teams, you’ll help deliver the service and results that set us apart. Your contributions directly support client satisfaction and the financial integrity of our business, making you a key part of our success.
What you’ll do:
Clearly communicate both written and verbally with confidence to internal and external customers.
Work collaboratively with cross functional teams.
Prepare and submit initial & subsequent claims to the stop loss carrier as requested.
Maintain record of submissions.
Follow-up as needed on stoploss filings and communicate with the client, broker and/or stop loss carrier as necessary.
Research individual claim disputes and provide resolution.
Responsible for internal and external customer satisfaction in the resolution of claims.
Monitor and track total reimbursement dollars for clients and prepare reporting for internal and external customers.
Track reimbursement of claims and provide support for accurate payment reconciliation.
Ensure all claim payments are issued upon receipt of stoploss funding.
What you’ll bring:
Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services; self-funded healthcare experience preferred.
The ability to meet performance goals, including accuracy and productivity.
Working knowledge of medical and dental benefit designs and interpretations.
Able to express ideas clearly in writing and conversation.
Knowledge of negotiation strategies related to healthcare claims.
Effective organizational and time management skills. Must be able to work independently without supervision and have demonstrated experience in exercising appropriate decision-making.
Initiative and self-motivation, with the ability to effectively solve problems as they arise.
Ability to research individual claim disputes and provide resolution.
Strong working knowledge of Microsoft Excel, including formulas and data organization.
Ability to demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated.
Compensation Range:$21/hr - 30/hr
Requirements
Two (2) years of experience in stop loss, claims operations, financial analytics, customer service, or client services; self-funded healthcare experience preferred.
The ability to meet performance goals, including accuracy and productivity.
Working knowledge of medical and dental benefit designs and interpretations.
Able to express ideas clearly in writing and conversation.
Knowledge of negotiation strategies related to healthcare claims.
Effective organizational and time management skills. Must be able to work independently without supervision and have demonstrated experience in exercising appropriate decision-making.
Initiative and self-motivation, with the ability to effectively solve problems as they arise.
Ability to research individual claim disputes and provide resolution.
Strong working knowledge of Microsoft Excel, including formulas and data organization.
Ability to demonstrate, manage and maintain Stop Loss relationships with multiple carriers. Ensure carrier procedural requirements are updated.
Skills Required
- Two years of experience in stop loss, claims operations, financial analytics, customer service, or client services; self-funded healthcare experience preferred.
- Ability to meet performance goals, including accuracy and productivity.
- Working knowledge of medical and dental benefit designs and interpretations.
- Ability to express ideas clearly in writing and conversation.
- Knowledge of negotiation strategies related to healthcare claims.
- Effective organizational and time management skills; ability to work independently and exercise appropriate decision-making.
- Initiative and self-motivation, with the ability to solve problems as they arise.
- Ability to research individual claim disputes and provide resolution.
- Strong working knowledge of Microsoft Excel, including formulas and data organization.
- Ability to manage and maintain stop-loss relationships with multiple carriers and keep carrier procedural requirements updated.
What We Do
Aither Health is a healthcare solutions company serving third-party administrators and risk-bearing entities, including self-funded employers, health plans, and providers. It offers innovative products and services designed to reduce healthcare cost trends through a transparent service model, carefully selected vendor partners, and collaborative care-delivery models. The company emphasizes physician-led care and stronger patient relationships to improve health outcomes while lowering overall healthcare costs.
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