Stop Loss Filing Coordinator

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.

Primary Responsibilities:

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.

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.

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.

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.

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.