[Hiring] Stop Loss Training Lead @Personify Health

Role Description

Ready to be the go-to expert who turns stop loss complexity into reimbursement wins?

Every self-funded plan we serve depends on getting stop loss right, and that starts with someone who knows the contracts inside and out. As Stop Loss Lead, you’re the department’s technical authority, the person who makes sure eligible reimbursements get submitted, tracked, and collected instead of left on the table. Your audits catch problems early, your training makes the whole team sharper, and your process improvements make every claim move faster and cleaner. The stronger your expertise and the quality of your work, the stronger our reimbursement outcomes, our client relationships, and the department as a whole.

What You’ll Actually Do

• Serve as the stop loss authority:
  • Act as the department’s subject matter expert on administration, reimbursement, and contract interpretation, giving the team a trusted source for answers on complex questions.
• Dig into contracts and carrier requirements:
  • Review stop loss contracts, plan documents, and carrier requirements in depth to ensure compliance and capture every reimbursement opportunity available.
• Drive reimbursements to resolution:
  • Support the submission, tracking, and reconciliation of stop loss claims, and work aging items, carrier inquiries, disputes, and escalated cases through to closure.
• Audit for quality:
  • Conduct regular reviews of claim submissions, reimbursement tracking, documentation, and correspondence to confirm accuracy and completeness, then report results and performance metrics to leadership.
• Turn findings into fixes:
  • Spot recurring errors, trends, and process gaps in audit results, develop corrective action recommendations, and partner with leadership to put them in place.
• Build and coach the team:
  • Onboard new Stop Loss Specialists, create and maintain training materials and standard operating procedures, and deliver coaching and refresher sessions that close knowledge gaps.
• Improve how we work:
  • Evaluate workflows, lead or support process improvement initiatives, and help roll out new tools and best practices, including testing and validating system updates.
• Own reporting and audit readiness:
  • Review and help prepare monthly stop loss and reimbursement reporting and carrier submissions, support internal and external audit requests, and keep documentation accurate and current.
• Step in where it counts:
  • Process stop loss claims and handle related operational work when workflow demands require it, and contribute to special projects that advance department goals.

Qualifications

• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• 3-5 years of experience in stop loss, self-funded health plan administration, claims, or related healthcare required
• Advanced claims processing and reimbursement experience strongly preferred
• Experience interpreting stop loss contracts and plan documents preferred
• Experience conducting audits, quality reviews, or process improvement initiatives preferred
• Experience training or mentoring team members preferred
• Advanced knowledge of stop loss administration, reimbursement processes, and contract interpretation
• Working knowledge of medical terminology and CPT, HCPCS, and ICD-10 coding (preferred)
• Proficiency in Microsoft Excel, Word, Outlook, and reporting tools
• Auditing and data analysis skills, including identifying trends and building data-driven recommendations

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use what we build)
• Unlimited PTO—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health