Stop Loss Claims Manager
About The Position
Stop-Loss Claims Manager oversees the administration, data collection, submission, and resolution of stop-loss insurance claims, ensuring accuracy, compliance, and timely processing for both Individual Stop Loss (ISL) and Aggregate Stop Loss (ASL). This role serves as a critical liaison between employers, third-party administrators (TPAs), brokers, and carriers, managing high-cost claims that exceed predetermined thresholds. Specialty Program Group (SPG) is the wholesale & MGA division of HUB International (5th Largest Global Broker). SPG acts in a holding company capacity acquiring best in class underwriting businesses to operate independently under discrete brands (portfolio companies). Strategic Benefit Resources provides complete facilitation of specific and aggregate stop loss claims. Our comprehensive approach begins with a thorough review of the claims submission and ends with an expedited and accurate reimbursement.
Requirements
- Understanding of stop-loss insurance, medical claims, and healthcare regulations.
- Strong analytical and decision-making skills (thinking outside the box)
- Excellent communication skills.
- Proficiency in Outlook, SalesForce, Excel and Data Analytics tools.
- Ability to manage sensitive personal health information with discretion and professionalism
- 2-5 years of relevant experience
Nice To Haves
- Utilization of a multitude of data analytics platforms
Responsibilities
- Review, evaluate, and process complex stop-loss claims, ensuring they meet policy terms and conditions.
- Analyze large-dollar claims for potential coverage issues, exclusions, and reimbursement eligibility.
- Communicate with TPAs, brokers, and internal departments to gather necessary documentation and clarify claim details.
- Ensure claims are handled in accordance with regulatory guidelines, contractual obligations, and internal standards.
- Generate detailed reports on claim activity and recovery outcomes to support underwriting and finance teams.
- Identify opportunities to streamline workflows, enhance claim accuracy, and improve turnaround times.
- Provide collaboration and guidance to fellow team members, support training initiatives, and contribute to departmental strategy.
Benefits
- health/dental/vision/life/disability insurance
- FSA, HSA and 401(k) accounts
- paid-time-off benefits
- eligible bonuses, equity and commissions for some positions
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
