Stop Loss Document Specialist

Job Description

Job Title :

Stop Loss Document Specialist

Status : Non Exempt / Hybrid

Why this role is important :

The Document Specialist plays a key support role in the Stop Loss submission process by gathering, organizing, and coordinating all necessary documentation to ensure timely and accurate claim submissions. This position works closely with the Stop Loss Submission Coordinator, Stop Loss Administrators, and external carriers to support efficient processing, follow-up, and appeals.

What you’ll do :

Collect and organize all ancillary documents required for stop-loss claim submissions, including but not limited to medical records, EOBs, and claim histories.

Notify the Stop Loss team once all required documentation has been gathered and the submission is ready for processing.

Respond to carrier requests by gathering and providing any additional documentation or clarifications needed after their initial review.

Support the Stop Loss Coordinator by obtaining all necessary information for claim appeal packages in cases of denial or partial funding.

Maintain accurate tracking and version control of all documents to ensure compliance and timely response.

Collaborate with internal departments (e.g., claims, case management, client services) to source missing or clarifying materials.

Uphold data privacy standards and ensure secure handling of all protected health information (PHI).

What you’ll bring :

High school diploma or equivalent

Minimum of 1-2 years of work experience

Strong attention to detail and organizational skills

Ability to manage multiple priorities and deadlines in a fast-paced environment

Intermediate knowledge of Microsoft Excel, including formulas and data organization.

Excellent written and verbal communication skills

Compensation Range : $17 / hr - 19 / hr

Physical Requirements :

Prolonged period sitting at a desk and working on a computer and the ability to lift 15 pounds.

Requirements

What you’ll bring :

High school diploma or equivalent

Minimum of 1-2 years of work experience

Strong attention to detail and organizational skills

Ability to manage multiple priorities and deadlines in a fast-paced environment

Intermediate knowledge of Microsoft Excel, including formulas and data organization.

Excellent written and verbal communication skills

Requirements

What you'll bring : Bachelors degree in paralegal studies or related field preferred. Paralegal certificate required. Excellent verbal and written communication skills. 3 years of legal work in a TPA or related industry. Previous contract experience. Understanding of legal language and principles, research methods, court pleadings and processes, and other related matters. Excellent organizational and interpersonal skills. Excellent attention to detail. Ability to function in a fast paced and at times stressful environment. Ability to maintain confidentiality and to exercise discretion and good judgment. Proficient in Microsoft office suite or related software.