Remote Examiner – Stop Loss

Remote Examiner – Stop Loss at Symetra

Symetra is seeking a Remote Examiner – Stop Loss to support excess loss claims administration through claim auditing, reimbursement analysis, policy review, and claims processing activities. This position plays an important role in ensuring claim reimbursements are accurate and compliant with policy provisions, plan documents, and administrative agreements.

This Remote Stop Loss Claims Examiner role fits best as a low-to-moderate phone insurance position. Team members spend most of their day reviewing documentation, analyzing claims, auditing submissions, researching policy provisions, and processing reimbursement decisions. However, regular communication with TPAs, internal departments, policyholders, and other stakeholders is required to obtain information, resolve claim issues, and support reimbursement decisions.

Primary responsibilities include reviewing excess loss claim submissions, analyzing employer plan documents, evaluating policy provisions, reviewing administrative agreements, and determining reimbursement eligibility. Specialists process reimbursements, document claim activity, maintain pending claim inventories, and ensure claims are handled accurately and within established turnaround times.

Additional responsibilities include reviewing advance notices of potential claims, identifying opportunities for cost containment, escalating catastrophic claim risks, coordinating with Medical Risk Consultants, and supporting underwriting teams with claim-related information. Team members also assist with appeals, inquiries, claim resolutions, and ongoing claim management activities.

The position requires strong analytical skills, attention to detail, organizational abilities, and proficiency with Microsoft Excel. Successful candidates are comfortable reviewing large amounts of documentation, interpreting policy language, researching claim information, and maintaining high accuracy standards in a deadline-driven environment.

Symetra offers a remote-first work environment, annual bonus eligibility, flexible work arrangements, retirement benefits, paid time off, professional development opportunities, and a supportive company culture focused on employee growth and success.

Overall, this position is an excellent fit for professionals who enjoy documentation review, claim analysis, reimbursement research, compliance support, insurance operations, and investigative work within a remote environment.