Stop Loss Claims Specialist

Allied is seeking a Stop Loss Claims Specialist to join their team, responsible for identifying, tracking, reviewing, and processing stop-loss reimbursement claims for carriers within an MGU stop-loss operation. The ideal candidate will possess strong knowledge of medical claims, stop-loss policy interpretation, and large-claim management in a self-funded or TPA environment. This role involves interpreting stop-loss contracts and plan documents to determine reimbursement eligibility and claim disposition. The specialist will also monitor high-cost claims, prepare claim activity reports, and ensure accurate claim handling with clear audit trails.