Stop Loss Claims Resolution Consultant

The Claims Resolution Consultant serves as a subject matter expert in Stop Loss medical claims, acting as the primary point of contact for complex claim inquiries and escalations. This role involves researching and resolving advanced inquiries regarding eligibility, reimbursement, and contractual interpretation while partnering with internal teams to ensure accurate outcomes. The consultant provides consultative guidance to stakeholders, manages inquiries from intake to closure, and ensures compliance with privacy and regulatory requirements.