Job Details


Company name
Medical Mutual of Ohio.

Copley, OH

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Stop Loss Administrator




Administers the notification, preparation, filing and balancing of routine to moderately complex stop loss claims in accordance with plan policies and reinsurer specifications. Monitors stop loss reimbursement amounts to ensure timely receipt from carriers.


· Compiles the information necessary for the filing and reimbursement of stop loss routine to moderately complex claims. This includes balancing of stop loss cases, obtaining itemized bill, explanation of benefits, Rx details and confirmation of work status

· Provides customer service via verbal and written communication with account service representatives, providers, plan sponsors and stop loss carriers

· Reviews daily stop loss reports to identify initial and subsequent submissions to carrier

· Associate’s degree in Business Administration, Accounting or related filed or equivalent combination of training and experience

· 2 years experience in health insurance claims, claims stop loss or related operations, preferably in third party administration setting

· Knowledge of medical terminology

· Knowledge of health insurance services and operations, especially medical claims processing

· Intermediate Microsoft office skills

· Good math skills

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

Top Workplace in Northeast Ohio. Seven years in a row we've received this recognition!

On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!

On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations

Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member

Business casual attire

Excellent Benefits and Compensation:

Competitive compensation plans

Employee bonus program

401(k) with company match and an additional company contribution

Excellent medical, dental, vision, and disability insurance

An Investment in You:

Career development programs and classes

Mentoring and coaching to help you advance

Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for 80 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing./


*7 - General Staff


*MHS Operations


Stop Loss Administrator



Requisition ID:


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Company info

Medical Mutual of Ohio.
Website :

Company Profile
Medical Mutual has been a trusted health insurer for 80 years. We are the oldest and largest health insurance company headquartered in the state of Ohio. We invite you to learn more about Medical Mutual, including the latest news, career opportunities and more.Service and value set Medical Mutual and its Family of Companies apart. A trusted insurer for 80 years, we are the oldest and largest health insurance company headquartered in the state of Ohio. As a mutual company, we operate for the benefit of our members without needing to meet the demands of stockholders or Wall Street analysts. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

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