Stop Loss Specialist

requirements. Review claims data to validate eligibility, plan

benefits, accumulators, provider billing accuracy, and patient responsibility prior to submission. Track reimbursements and reconcile payments against expected recoveries. Maintain timely follow-up with stop loss carriers to resolve outstanding items or additional documentation requests. High-Cost Claimant Oversight Identify potential stop loss claimants through daily/weekly high-dollar reporting. Monitor claims approaching the specific deductible and ensure accurate accumulation. Maintain updated logs for submission tracking purposes. Policy & Contract Administration Review stop loss policies to ensure adherence to contract terms, exclusions, and filing deadlines. Coordination & Communication Serve as the primary contact for stop loss carriers and employer groups regarding claim statuses and policy questions. Collaborate closely with Claims team members to gather needed documentation. Data Integrity & Reporting Maintain accurate and secure records of all stop loss claims and reimbursement records. Ensure all documentation meets audit and compliance standards. Who We’re Looking For: We’re seeking a motivated, ethical, and compassionate individual who thrives in a fast-paced, detail-oriented environment and is passionate about delivering fair and accurate outcomes. If you’re passionate about doing the right thing and bringing integrity to every claim, we’d love to hear from you. Ideal Candidates Would Possess: Experience in healthcare claims processing, preferably within a mid-sized TPA operating in the self-funded space A strong commitment to accuracy and attention to detail The ability to prioritize workload effectively in a fast-paced environment Strong communication skills What Will Make You Stand Out: Experience in stop loss administration, medical claims processing, or self-funded health plan operations (typically 2–5 years). Strong understanding of medical claims, ICD-10, CPT, billing rules, and plan document interpretation. Knowledge of stop loss concepts (specific/aggregate deductibles, lasers, reimbursement timelines). Proficiency in claims platforms, Excel, and reporting tools. Excellent analytical and problem-solving skills. Strong communication and time-management abilities.

Why Join Us: Equity opportunities Competitive Salary Approximately $80 - $90k in annual salary depending on experience, location, and desired equity Health

benefits 401K with Employer matching Career growth and development opportunities Remote capabilities We are a high-trust team with radically high transparency and autonomy Our Interview Process: If you’re selected for an interview, here’s what you can expect: Initial 30–45 minute video conversation with Claims Operations Leadership Follow-up conversation with members of the broader Operations Leadership team Take-home assignment (approx. 2 hours) designed to reflect real on-the-job work Reference checks with 1–2 individuals you provide Possible onsite visit to our NYC office, depending on your location and role expectations Apply Name * Email * LinkedIn * Resume What's the coolest thing you've done? * Could be about anything! We love passionate people. Why Yuzu? Check me! If you're a normal human, don't check the above Submit Company About Careers Blog Changelog For Providers Claim Status Eligibility Check For Members Go Paperless Pages Customers Solutions For Brokers Platform Terms of Service Privacy Policy Accessibility Statement Fulfillment Policy Vulnerability Disclosure Trust Center Connect Contact Us LinkedIn Github Party

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