About the role
Overview
Who We Are
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.
Learn even more about the work that drives us at personifyhealth.com.
Responsibilities
Ready to be the go-to expert who turns stop loss complexity into reimbursement wins?
Why This Role Matters
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
What You Bring to Our Team
Education & Experience:
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
Technical Skills:
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
The Highlights:
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
Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.
Compensation: This position offers a base salary range of $65,000 - $73,000, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.
Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.
Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to . View all legitimate openings at personifyhealth.com/careers.
Originally posted on Himalayas