Stop Loss Specialist

The Stop Loss Specialist serves as the operational core of the stop loss filing process, managing claimants, tracking reimbursements, and ensuring accurate, timely filings that protect clients and recover funds. This role involves assessing claim eligibility, maintaining detailed claimant files, and coordinating communication between pharmacy benefit managers and internal stakeholders. The specialist is responsible for monitoring reinsurance requests, following up with carriers to resolve outstanding items, and escalating disputes to leadership.