Aggregate Stop Loss Specialist

Assured Benefits Administrators, Inc. (ABA) is a full-service third-party administrator, or TPA, providing flexible and fully integrated healthcare administration and management solutions across the United States since 1985. We are part of an international healthcare group with more than 35 years of industry experience, and we’re fully integrated with our long-term partners, who are recognized as industry leaders.

ABA is a certified “Great Place to Work”, united by a single mission: standing with members through every moment and milestone in their healthcare journey. With decades of industry experience and a team driven by passion, integrity, and excellence, ABA is committed to delivering connected, transparent, and innovative healthcare solutions to employers and members across the United States.

POSITION SUMMARY

The Aggregate Stop Loss Specialist manages aggregate reporting and filings for self-funded and level-funded clients. The role requires strong claims knowledge to research, reconcile, and file aggregate reimbursements and monthly accommodations accurately and on time, while coordinating across internal teams, clients, and stop-loss carriers to ensure compliance, data integrity, and audit readiness.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

• Coordinate and file Aggregate Reimbursements and Monthly Accommodation requests in accordance with carrier policies, plan documents, and internal procedures.
• Perform detailed research using claims data to validate thresholds, accumulators, and eligibility supporting reimbursements and payments; resolve discrepancies.
• Respond promptly and thoroughly to audit requests; gather and review documentation for accuracy and appropriateness before release.
• Document authorizations and denials from stop-loss carriers; track escalations and approvals related to claim payments.
• Maintain professional communication with internal teams, vendors, carriers, brokers, and clients to progress filings and resolve issues.
• Operate independently while meeting deadlines, service levels, and compliance standards.
• Manage and track received, pended, and completed claim files with clear status visibility and audit trails.
• Assist with administrative tasks and special projects that support the stop-loss function.

Other job duties include, but are not limited to the following:

• May perform other duties as assigned.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

• Associate degree preferred; equivalent combination of education and experience considered.   
• Intermediate level computer skills, including Microsoft Word, and Outlook
• Advanced Excel required
• A high school diploma or GED certificate
• At least 3 years' experience as a claim’s examiner processing first dollar medical claims
• Stop loss insurance knowledge required
• Overall knowledge of the healthcare industry
• Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
• Strong communication and organizational skills
• Excellent written and verbal communication skills

OTHER DETAILS

Supervisory Responsibilities

None.

Work Environment

The noise level in the work environment is usually low to moderate.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.

Travel Requirements

None.