Sr. Stop-Loss Operations Specialist

Health Plans Inc

4h•Onsite

About The Position

The Senior Stop Loss Operations Specialist is an experienced professional responsible for the accurate and timely preparation, submission, and reconciliation of stop‑loss filings (both specific and aggregate) for assigned groups. This role supports internal and external clients, mentors team members, conducts quality audits, and ensures compliance with stop loss policies, plan documents, and operational standards. The Specialist serves as a subject matter expert, collaborates across departments, and plays a key role in training, process improvement initiatives, and claims inventory preparation for monthly stop‑loss renewals.

Requirements

2+ years of experience in stop loss administration, self-funded health plans, finance operations, or a related role within a TPA, carrier, or benefits administration environment.
Strong understanding of claims funding and stop loss workflows and financial controls.
Working knowledge of traditional stop loss, captive stop loss, and/or level‑funded programs.
Familiarity with banking processes, ACH funding, and reconciliation.
Proficiency with shared inbox management, tracking tools, and reporting.
Excellent organizational skills with the ability to manage multiple priorities and deadlines.
Strong written and verbal communication skills, including professional client correspondence.
High attention to detail and problem‑solving abilities.
Work within specified timeframe and meet deadlines.
Strong customer service orientation and ability to build relationships.
Risk awareness and escalation judgment
Demonstrated commitment to maintaining confidentiality and ethical practice.
Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Nice To Haves

Experience supporting self‑funded health plans and employer‑funded claim payment models.
Experience in handling escalations or delinquent account management.
Experience working directly with stop loss carriers, brokers, and employer groups.
Familiarity with trend analysis, root cause analysis, or operational optimization initiatives.
Proficiency with claims administration systems (Javelina) and financial tracking tools (Ringmaster).
Experience with process improvement methodologies (Lean, Six Sigma, etc.).

Responsibilities

Train new hires and provide ongoing training to reinsurance/stop‑loss staff.
Coach analysts on best practices and standard operating procedures
Provide subject matter support for staff questions
Prepare and submit specific and aggregate stop‑loss reimbursement requests accurately and timely, following SOPs.
Prepare and file weekly level funding accommodations, monthly aggregate accommodations, and annual aggregate filings.
Administer advance funding when included in a group’s stop‑loss policy.
Efficiently address questions and requests for information from the stop loss carriers and gather all supporting documentation from corresponding departments as necessary
Correspond with clients to verify that enrollment eligibility was maintained based upon plan documentation
Reconcile monthly and year end reporting to reflect reimbursements, refunds, voids, etc.
Assist with researching and resolution of client issues related to stop loss transactions.
Provide reporting to internal and external stakeholders as needed.
Evaluate opportunities for process improvement and implement solutions that produce measurable results.
Anticipate and understand systems interactions to improve efficiency and accuracy