Who We Are

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

We're seeking a detail-oriented professional who can support the coordination and filing of Stop Loss claims, Advance Funding requests, and Plan Year End Closeouts. As our Stop Loss Specialist, you'll serve as the critical liaison between clients, Stop Loss carriers, and internal teams while ensuring timely processing of specific reimbursement requests and maintaining comprehensive tracking of all Stop Loss activities.

What makes this role different:

✓ Financial protection focus: Determine Stop Loss filing eligibility for claims applicable to Excess Loss Policy, directly impacting client financial protection

✓ Cross-functional coordination: Act as liaison between PBMs and internal clients for Stop Loss claimants while coordinating Advanced Funding Requests

✓ Process ownership: Maintain database of all specific reimbursement requests while creating and managing initial Specific Files for each claimant

✓ Compliance tracking: Monitor all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reports

What You'll Actually Do

Prepare Stop Loss submissions: Analyze Stop Loss claims and applicable documents to determine filing eligibility under Excess Loss Policy while processing all submissions within established timeframes.

Coordinate funding requests: Manage Advanced Funding Requests with clients and Stop Loss carriers while maintaining comprehensive database of all specific reimbursement requests.

Manage documentation systems: Create initial Specific File for each claimant and file all submissions in EDOCS platform while coordinating release of Over Specific, System Hold claims.

Serve as liaison: Act as connection point between PBMs and internal clients for Stop Loss claimants while maintaining professional communication with all stakeholders.

Monitor reimbursements: Track all reinsurance requests to ensure receipt of reimbursement while generating weekly outstanding reimbursement reports and following up with carriers.

Support plan year activities: Assist with Plan Year End Closeouts while keeping immediate supervisor apprised of open or disputed items requiring attention.

Maintain workflow excellence: Contribute to daily workflow with regular, punctual attendance while performing related or assigned duties as required.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What You Bring to Our Mission

The foundational experience:

• High school diploma or general education degree (GED) required
• Minimum 3 years related experience and/or training, or equivalent combination of education and experience
• Completion of training programs through HIPAA, ICA and/or LOMA, and continuing education courses relative to Stop Loss preferred

The technical expertise:

• Knowledge of medical terminology, CPT, HCPCS, and ICD-10 codes
• Computer literacy with proficiency in Windows and Microsoft Office environment (Word, Excel, Outlook)
• Knowledge of insurance database systems preferred
• Experience with EDOCS platform or similar documentation management systems

The analytical competencies:

• Detail-oriented, analytical, financially minded approach to Stop Loss coordination
• Ability to read, analyze, and interpret common financial reports and legal documents
• Capability to work with mathematical concepts such as probability and statistical inference
• Skills to apply concepts like fractions, percentages, ratios, and proportions to practical situations

The professional qualities:

• Strong written and verbal communication skills for professional interaction with diverse stakeholders
• Ability to organize, prioritize, and multitask in fast-paced environment
• Demonstrate ability to work independently with excellent judgment and decision-making
• Capability to respond to inquiries or complaints from customers, regulatory agencies, or business community members
• Ability to effectively present information to top management, public groups, and boards of directors
• Problem-solving skills to deal with variety of concrete variables in situations with limited standardization
• Capacity to interpret instructions furnished in written, oral, diagram, or schedule form
• Professional, respectful, and courteous approach in all position-related conduct

Why You'll Love It Here

We believe in total rewards that actually matter—not just competitive packages, but benefits that support how you want to live and work.

Your wellbeing comes first:

• Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!)
• Mental health support and wellness programs designed by experts who get it
• Flexible work arrangements that fit your life, not the other way around

Financial security that makes sense:

• Retirement planning support to help you build real wealth for the future
• Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
• Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage

Growth without limits:

• Professional development opportunities and clear career progression paths
• Mentorship from industry leaders who want to see you succeed
• Learning budget to invest in skills that matter to your future

A culture that energizes:

• People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
• One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
• We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
• Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable

The practical stuff:

• Competitive base salary that rewards your success
• PTO policy because rest and recharge time is non-negotiable
• Benefits effective day one—because you shouldn’t have to wait to be taken care of

Ready to create a healthier world while building the career you want? We're ready for you.

No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you.

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $19.00 to $22.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for medical, dental, vision, and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.