Stop Loss Manager

Lucent Health Solutions LLC • Nashville, TN

1d

About The Position

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers. We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.

Requirements

• Minimum of 5–7 years of experience in self-funded healthcare, stop loss administration, or claims management.
• Prior management or team lead experience in a TPA or insurance carrier environment is required.
• Hands-on knowledge of specific and aggregate stop loss plans and administration.
• Strong leadership, communication, and interpersonal skills.
• Proficiency in Microsoft Office Suite, including Excel for reporting and analysis.
• High attention to detail with strong analytical and organizational capabilities.
• Ability to manage multiple priorities under strict deadlines.
• Knowledge of regulatory compliance, underwriting principles, and TPA operations.

Nice To Haves

• Experience implementing process improvements and quality control initiatives.
• Familiarity with stop loss software platforms and claims management systems.
• Strong client relationship management skills and ability to act as a subject matter expert.

Responsibilities

• Supervise and mentor the stop loss claims team, providing guidance on complex cases and workflow management.
• Conduct performance evaluations, identify training needs, and foster professional development.
• Implement best practices for auditing, quality assurance, and operational efficiency within the team.
• Oversee the preparation, submission, and follow-up of specific and aggregate stop loss claims to ensure timely reimbursement from carriers.
• Review high-dollar claims, coordinate advance funding, and monitor group and plan year-end claims activity.
• Ensure compliance with stop loss policy contracts, regulatory guidelines, and internal SOPs.
• Serve as primary point of contact for clients and brokers regarding stop loss claim inquiries, renewals, contract interpretations, and resolution of escalated issues.
• Provide strategic risk analysis and reporting to support client decision-making and contractual obligations.
• Analyze team workflows and identify opportunities for process enhancements, automation, and efficiency gains.
• Maintain accurate records, dashboards, and reporting of stop loss activity for leadership and carrier review.
• Ensure adherence to HIPAA, ERISA, and applicable state and federal regulatory standards.
• Work closely with finance, claims and client services to verify attachment points, contract alignment, and funding requirements.
• Coordinate with internal departments to ensure seamless plan administration and claim resolution.
• Monitor aggregate claim levels, policy limits, and excess exposure across the book of business.
• Identify trends in stop loss claims to support predictive risk modeling and cost-containment strategies.

What This Job Offers

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