Stop-Loss Coordinator

Full Time

Clerical

US

Salary Range: $21.00 To $24.00 Hourly

Position: Stop Loss Coordinator

Department: Reinsurance

Reports To: Manager, Stop Loss

FLSA Status: Non-exempt

Health Plans, Inc. (HPI) is a New England-based Third-Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities, and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security.

Summary:

This position will provide administrative support to the Reinsurance Department.

Duties and Responsibilities (other duties may be assigned):

• Request and gather enrollment documentation, active at work status forms, and other insurance information for members based on stop loss activity

• Generate other insurance correspondence to members based on stop loss activity

• Retrieve and compile claim copies, invoice backup, itemized bills and member correspondence as needed to support stop loss filings, carrier requests, and internal reviews

• Perform timely follow-up within established timeframes and escalate missing or incomplete documentation, referring unresolved items to the Stop Loss Specialist or leadership team to prevent delays, denials, or compliance risk

• Preparing and complete Explanation of Reimbursement (EOR) journal entries ensuring accuracy and timeliness

• Identify and refer any pends or denials noted on EOR(s) to the Stop Loss Specialist for review, resolution, and follow-up

• Prepare letters and summaries to accompany EOR(s) and checks for internal and external communication

• Maintain the carrier refund log, prepare cover letters and forward refund checks to carriers as required

• Maintain accurate records and logs of completed stop loss support activities in accordance with departmental standards

• Adhere to confidentiality requirements and ensure compliance with internal policies and regulatory standards

Minimum Education Requirements (must have documented proof*):

• High School Diploma or equivalent

Minimum Experience Requirements:

• Two or more years of experience in administrative, claims, benefits, insurance, or healthcare office environment handling documentation, records, and/or financial transactions

• Prior experience working within established procedures and escalation protocols

Preferred Education Requirements:

• Associate’s degree

Preferred Experience Requirements:

• Communicate effectively, both verbally and in writing

• Ability to work both independently and as a team member

• Must be detail oriented, analytical and accurate

• Recognize the need for follow-thru and follow-up

• Ability to work within specified timeframe and meet deadlines

• Experience working with confidential or sensitive information

• Experience in a regulated or compliance-driven environment

Computer Skills:

• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Reasonable Accommodation:

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.

Working Environment/Physical Demands:

The work environment characteristics and physical demands described here are representative of those an employee may encounter while performing the duties of this job.

The noise level in the work environment is moderate. The employee may occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, walk, speak, or hear. The employee is frequently required to use hands or feel or handle items as well as reach with hands and arms. The employee is occasionally required to stand.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.

Health Plans Inc. is an EEO – M/F/D/V employer

*** Application Deadline 4/24/26