Specific Stop Loss Claims Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Specific Stop Loss Claims Auditor based in the United States.

The Specific Stop Loss Claims Auditor will support claims data coordination and analysis for key clients with stop loss policies managed outside pharmacy benefit managers (PBMs) and other third-party administrators. This role focuses on identifying specific stop loss claimants, preparing accurate data for claim entry, and helping ensure reliable claims operations. The successful candidate will use analytical expertise to interpret claims information, develop dashboards, and communicate meaningful insights to leadership. In addition to day-to-day data analysis, the position will contribute to continuous improvement initiatives that enhance processes and operational effectiveness. Working in a remote, collaborative environment, the role offers an opportunity to apply claims knowledge and analytical skills to support client needs and informed business decisions.

Accountabilities

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Identify specific stop loss claimants and coordinate the relevant data required for accurate claim entry.

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Analyze claims data and support data coordination initiatives for primary clients whose stop loss policies are managed outside PBMs or other administrators.

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Prepare, organize, and validate claims information to support efficient and reliable claims operations.

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Build and maintain dashboards that provide visibility into claims data, trends, and operational performance.

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Present analytical findings and relevant insights to leadership to support informed decision-making.

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Identify opportunities to improve data processes, claims workflows, and operational efficiency.

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Drive and contribute to continuous improvement projects focused on strengthening claims data coordination and analysis.

Requirements

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At least 3 years of experience in claims data analysis or claims operations.

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Analytical background and knowledge of specific stop loss claims.

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Bachelor's degree in Business, Analytics, or a related field, or comparable professional experience.

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Strong analytical and data interpretation skills, with the ability to identify relevant trends and insights.

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Ability to organize and prepare claims data accurately for operational use.

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Experience developing dashboards and presenting findings to leadership.

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Strong communication and collaboration skills, including the ability to explain analytical information clearly.

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A proactive, detail-oriented approach to problem-solving and continuous process improvement.

Benefits

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Compensation: $35.00–$38.00 per hour.

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Medical and prescription drug coverage.

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Dental and vision insurance.

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Life and disability insurance.

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Employee Stock Purchase Plan (ESPP).

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401(k) retirement plan.

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Student loan assistance.

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Tuition reimbursement.

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Free mental health services and enhanced advocacy support.

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Paid time off and holidays.

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Preferred partner discounts and additional well-being benefits.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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