Stop Loss Analyst

Lucent Health Solutions LLC • Nashville, TN

11h

About The Position

The Stop Loss Analyst plays a pivotal role in managing financial risk associated with self-funded health plans. This position supports the underwriting and claims processes by evaluating large claims, tracking stop loss reimbursement trends, and ensuring accurate and timely submissions. Ideal candidates will combine analytical rigor with industry knowledge to protect the TPA and its clients from catastrophic claims exposure.

Requirements

• Bachelor's degree in Business, Finance, Health Administration, or related field (preferred)
• 2+ years of experience in stop loss claims or TPA operations
• Strong working knowledge of self-funded health plans and stop loss contracts
• Advanced Excel skills; proficiency in data analytics tools a plus
• Exceptional attention to detail and organizational skills
• Excellent communication and relationship management abilities

Nice To Haves

• Familiarity with ICD-10, CPT, and medical coding terminology
• Familiarity with LuminX or QicLink platforms
• Ability to interpret legal and contractual language
• Experience with claim adjudication systems or benefit platforms
• Independent and proactive problem-solving mindset

Responsibilities

• Evaluate large medical and pharmacy claims for stop loss reimbursement eligibility
• Assist in preparation and submission of stop loss claims to carriers, ensuring compliance with contract terms
• Monitor reimbursements and maintain status updates on pending claims
• Collaborate with internal departments (Claims, Care Management, Finance) to gather documentation
• Liaise with stop loss carriers to resolve claim issues and provide necessary support
• Maintain detailed records in accordance with regulatory and HIPAA standards
• Identify process inefficiencies and recommend improvements to optimize claims cycle time

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level