Reinsurance Specialist
About The Position
The Reinsurance Specialist will report to the Director of Underwriting. The Reinsurance Specialist ensures accurate, timely stop-loss premium, claims, reimbursement, and payment data for the health plan’s Self-funded accounts including reinsurance and LMF product by validating monthly sources and resolving variances with cross-functional teams and the vendor. They manage reinsurance inquiries via a centralized mailbox and maintain clear documentation and standard operating procedures (SOPs) for decisions and issue resolution. They also support compliance and close activities by coordinating stop-loss policy filings, settlement/ surplus reporting with the Settlement Coordinator, month/period-end tie-outs, and audit/reporting requirements aligned to reinsurance agreements. The individual will need to be self-motivated with the ability to work independently and within a team environment with strong follow-up, organization/prioritization skills, and excellent attention to detail. The individual is required to maintain confidential information/correspondence and be responsible for meeting extremely tight deadlines. Reinsurance Specialist should independently manage essential functions, teach those skills to staff, prioritize them and seek assistance from company UW management team members. These functions need to be performed on a consistent and regular basis, using strong judgment. Requires the ability to learn and apply all company Plan policies consistently. The Reinsurance Specialist is expected to seek guidance from Underwriting management when appropriate. Additional responsibilities include developing and maintaining reports using various systems.
Requirements
- Bachelor’s Degree (Mathematics, Statistics, Actuarial Science, Accounting, Finance, or other analytical discipline)
- 5-7 years’ experience in health plan finance/operations and/or claims finance
- Demonstrated experience supporting close cycles and working with external vendors
- Prior exposure to regulatory filing coordination
- Stop-loss (medical) reinsurance knowledge (policy terms, reimbursement mechanics, attachments/lasers, exclusions)
- Level monthly funded product familiarity (how premiums, claims funding, and settlements flow)
- Understanding of reinsurance agreement requirements and operational compliance obligations
- Familiarity with monthly data validation across sources, as well as financial reconciliations, tie-outs, and variance analysis
- Experience with root-cause analysis of data/process discrepancies
- Experience with SOP creation/maintenance and process documentation
- Experience with shared mailbox/work intake management and issue tracking
- Excellent verbal and written communication skills
- Well-developed verbal and written communication skills
- Ability to exercise sound judgment and raise issues to appropriate senior Underwriting leaders for resolution.
- Proficiency with MS Office applications (Excel, Access, Word, PowerPoint)
- Requires the ability to work collaboratively as part of a team.
- Must be able to effectively communicate with all internal departments in verbal and written formats.
Responsibilities
- Review reinsurance payment details for accuracy, completeness, and timeliness.
- Review and validate premium, claims, and reimbursement data to confirm alignment and quality across sources (monthly)
- Identify variances, investigate root causes, and coordinate resolution with the appropriate teams.
- Ensures stop‑loss policy filings are prepared, submitted, tracked, and kept compliant/approved with required regulators and internal governance
- Partner with the Settlement Coordinator to support settlement/ surplus reporting and related analyses.
- Support month-end and period-end close activities, including required tie-outs and documentation.
- Establish and manage reinsurance mailbox, respond to inquiries and route issues (Finance, Claims, Sales, etc.)
- Maintain documentation of decisions, resolutions, and standard operating procedures (SOPs)
- Support audit requests and reporting needs and ensure adherence to reinsurance agreement requirements.
Benefits
- Medical, dental and vision coverage
- Retirement plans
- Paid time off
- Employer-paid life and disability insurance with additional buy-up coverage options
- Tuition program
- Well-being benefits
- Full suite of benefits to support career development, individual & family health, and financial health
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
