A&H Senior Claims Cost Containment Analyst
About The Position
Westfield Specialty’s new A&H team has an opening for joining our expanding operation. As a key contributor on this highly experienced team, you'll help build a premier A&H reinsurance and insurance operation. This new team offers significant opportunities for career growth and development. The Senior Stop Loss Claims & Cost Containment Analyst supports the Accident & Health (A&H) team by serving as a forward-facing liaison to cost containment vendors and customers while also providing hands-on support to stop loss and reinsurance claims operations. This role is responsible for coordinating cost containment strategies, assisting in claims production, and helping manage claims inventory and volume to ensure timely, accurate, and compliant claim outcomes. The position partners closely with internal claims staff, underwriting, reinsurance partners, and external vendors to drive consistency, efficiency, and strong customer experience across the stop loss and reinsurance lifecycle. Successful candidates will have a strong knowledge of healthcare insurance policies, procedures, and regulations.
Requirements
- Bachelor’s degree or equivalent experience.
- 3–7 years of experience in stop loss claims, A&H claims, or reinsurance-related roles.
- Strong working knowledge of stop loss policy provisions and claims adjudication.
- Experience working with cost containment vendors and/or TPAs.
- Ability to manage multiple priorities in a high-volume, deadline-driven environment.
- Strong communication skills with the ability to interact confidently with internal and external partners.
- Excellent written, verbal, and interpersonal communication skills.
- Strong analytic, investigative, listening, and negotiation skills.
- A desire to be part of a new and growing team.
- Keen attention to detail.
- Ability to work independently.
- Demonstrated problem solving ability.
Responsibilities
- Assist with the day-to-day activities of the A&H reinsurance and stop loss claims function, from first notice through resolution.
- Provide exceptional customer service through all interactions and communications with internal and external business partners.
- Collaborate with management team on cost containment and claims operations
- Act as a primary point of contact for cost containment vendors (e.g., PPO networks, bill review, clinical management, specialty vendors).
- Coordinate cost containment workflows to support stop loss and reinsurance claims outcomes.
- Monitor vendor performance, turnaround times, and effectiveness; escalate issues as needed.
- Assist in evaluating cost containment opportunities and process improvements.
- Assist in reviewing, processing, and adjudicating stop loss and reinsurance claims in accordance with policy provisions and regulatory requirements.
- Assist in developing and refining workflows, checklists, and best practices for stop loss claims and cost containment.
- Contribute to training, knowledge sharing, and process documentation.
- Support special projects related to claims operations, reinsurance reporting, or vendor initiatives.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
