At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
Stop Loss Filing Coordinator
Location
United States
Posted
16 hours ago
Salary
$24 - $29 / hour
No structured requirement data.
Job Description
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
Point C is seeking a detail-oriented and organized Stop Loss Filing Coordinator to join our growing team. This position plays a critical role in managing the end-to-end stop loss claims process—serving as a liaison between internal stakeholders, clients, and stop loss carriers. The ideal candidate thrives in a deadline-driven environment, demonstrates exceptional communication and analytical skills, and is comfortable navigating complex policy documentation and claim data.
Key Responsibilities:
Claim Preparation and Filing
- Prepare and submit stop-loss claims and supporting documentation with a focus on accuracy and eligibility verification.
- Coordinate with internal teams, clients, and stop-loss carriers to ensure timely and complete claim submissions.
- Maintain precise records of all claims activity, including correspondence and supporting documentation.
Communication and Coordination
- Act as the primary point of contact between internal teams and stop-loss MGUs/carriers.
- Provide regular updates to clients and internal stakeholders regarding claim status, pending issues, and resolution timelines.
- Collaborate with Account Managers and Sales Executives to support quote renewals and policy reviews.
Data Management and Analysis
- Review and analyze stop-loss policies, quotes, applications, and plan documents to ensure alignment and consistency.
- Generate monthly financial data reports for internal and client-facing use.
- Maintain and update internal tracking spreadsheets for stop-loss claims activity.
Process Improvement
- Identify opportunities to streamline stop-loss filing processes and enhance overall efficiency.
- Participate in internal audits and contribute to team training and best practice development.
Other Duties
- Manage advanced funding requests in coordination with clients and stop-loss carriers.
- Support the broader stop-loss administrative function and ensure compliance with internal policies and regulatory requirements.
Qualifications:
- Strong attention to detail and organizational skills with the ability to manage multiple tasks and deadlines.
- Experience working in healthcare, insurance, or third-party administration (TPA) settings, particularly in stop-loss claims or underwriting.
- Proficiency in Microsoft Office Suite, especially Excel for tracking and reporting.
- Strong verbal and written communication skills for both internal and external correspondence.
- Ability to interpret complex policy language and reconcile information across multiple documents.
- A proactive, problem-solving mindset and commitment to continuous process improvement.
- Prior experience working with stop-loss MGUs or carriers is a plus.
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
-
Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
The role involves planning and managing all aspects of clinical trials, ensuring adherence to timelines, budget, and quality standards while collaborating with cross-functional teams. Responsibilities also include building relationships with investigators and ensuring compliance with all relevant regulations and ethical guidelines.
Workers Compensation Subrogation Specialist
Latitude Subrogation ServicesLatitude Subrogation Services (LSS) provides comprehensive recovery solutions as a leader in subrogation outsourcing. We have been delivering our best-in-class recovery services since 1997! Solutions for insurers, self-insured entities, third party administrators, and specialty risk companies as a subrogation vendor and purchaser of subrogation assets. Our Core Values Honesty and fairness Integrity in all aspects of our business Maintaining a respected reputation Teamwork Long-term relationships with client partners Win/Win for clients and employees
Responsible for the complete subrogation process of investigation, negotiation, and settlement of workers compensation claims that have been identified to have subrogation potential as assigned. Technical/Functional Responsibilities Subrogation Process: Navigates through our prop...
This role involves representing client employers at hearings before judicial bodies, primarily by negotiating California Workers' Compensation medical liens according to unit guidelines. Essential functions include preparing documentation for hearings, performing lien negotiations, and developing/maintaining technical training materials for the department.
The role involves analyzing and processing workers compensation claims through well-developed action plans to achieve timely resolution by investigating and gathering necessary information to determine claim exposure. Essential duties also include negotiating claim settlements within designated authority and professionally communicating claim activity to both the claimant and the client.
