Stop Loss Operations Specialist

Valenz•Phoenix, AZ

1d•Remote

About The Position

The Stop Loss Operations Specialist (also referred to as Stop Loss Operations Analyst) supports the financial and administrative operations of Valenz Health’s stop loss program. The role covers premium administration, policy issuance, licensing, reconciliation, and operational controls, ensuring transactions, policy documentation, and regulatory records are accurate, timely, compliant, and audit-ready. The specialist collaborates with Underwriting, Claims, Finance, TPAs, producers, carriers, and Stop Loss leadership to resolve exceptions and improve processes. Responsibilities include managing premium and policy workflows, licensing and due diligence records, financial reporting, audit support, controls, and operational reporting. The position is fully remote, requires a US-based work location, and the company provides necessary equipment. The employee needs a quiet workspace, reliable internet, and must follow company security protocols, including use of VPNs, secure passwords, and approved devices and software.

Requirements

At least 3 years of experience in insurance operations, premium administration, accounting or reconciliation, policy administration, or a related field.
Working knowledge of self-funded medical plans, employer stop loss terminology, insurance contracts, and operational workflows.
Strong reconciliation and analytical skills, with the ability to work accurately across premium, enrollment, policy, and financial data.
Ability to interpret policy and underwriting terms and identify discrepancies requiring additional review.
Experience managing financial or administrative processes with defined controls, deadlines, and documentation requirements.
Strong attention to detail and ability to maintain accurate, complete, audit-ready records.
Strong organizational and time-management skills, including the ability to manage multiple recurring processes and deadlines.
Effective written and verbal communication skills and ability to collaborate with carriers, TPAs, producers, Finance, Underwriting, Claims, and other internal partners.
Proficiency with Microsoft Office applications, including Excel and Word, and ability to learn stop loss administration, underwriting, and reporting platforms.
Ability to independently manage assigned operational processes within established procedures and appropriately escalate material exceptions.
US-based work location where the employee can work effectively and comply with company policies such as HIPAA.
Quiet workspace free from distractions, reliable internet connection, and adherence to company security protocols, including VPNs, secure passwords, and company-approved devices and software.

Nice To Haves

Bachelor’s degree in Accounting, Finance, Business, Insurance, or a related field.
Experience with employer stop loss, self-funded medical plans, premium administration, or policy issuance.
Experience with carrier bordereaux, month-end reconciliation, or insurance financial reporting.
Experience administering insurance licensing, carrier appointments, producer records, or related regulatory requirements.
Experience supporting policy preparation, endorsements, amendments, or quality review of insurance documents.
Experience with TPA or producer due diligence and approval processes.
Experience supporting carrier, financial, compliance, or operational audits.
Experience with stop loss administration, underwriting, policy, or reporting platforms.

Responsibilities

Manage financial and administrative operations supporting the stop loss program, including premium administration, policy issuance, licensing, reconciliation, and operational controls.
Ensure transactions, policy documentation, and regulatory records are accurate, timely, and audit-ready.
Partner with Underwriting, Claims, Finance, TPAs, producers, carriers, and Stop Loss leadership to resolve exceptions, maintain program requirements, and improve operational processes.
Administer premium receipts, lockbox and ACH activity, and application of premium to applicable groups and policies within stop loss systems.
Reconcile enrollment, expected premium, and received premium; coordinate resolution of shortages, overpayments, unapplied cash, delinquent premium, and other exceptions.
Coordinate return premium, commission and override payments, claim payment activity, and other assigned financial transactions with Finance and Accounts Payable, maintaining supporting reconciliation and documentation.
Perform monthly premium reconciliations and support month-end close, bordereaux, carrier reporting, and other program financial reporting.
Manage policy administration following final underwriting approval, including sold-case requirements, policy and form selection, policy preparation, amendments, endorsements, and outstanding-item tracking.
Review policy materials against approved underwriting terms and escalate discrepancies before issuance.
Coordinate policy issuance activities performed by Stop Loss Specialists and maintain documented procedures, quality controls, and status reporting.
Administer agency and producer licensing, carrier appointments, renewals, state-specific requirements, regulatory correspondence, and related documentation.
Maintain TPA and producer due diligence documentation and support applicable approval processes.
Develop and maintain operational procedures, reconciliations, exception reporting, controls, and audit evidence for premium, policy, and licensing activities.
Support carrier, financial, and internal audits and coordinate timely resolution and documentation of identified exceptions.
Develop operational reporting and identify opportunities to improve accuracy, efficiency, transparency, controls, and cross-training.
Coordinate workflows across Stop Loss Specialists and internal partners and escalate material underwriting, financial, contractual, or compliance matters to appropriate leadership.
Recommend process, control, and system improvements to Stop Loss leadership and functional partners.
Perform other duties as assigned.

Benefits

Generously subsidized company-sponsored medical, dental, and vision insurance.
HSA, FSA, and DCFSA spending account options.
401(k) with company match and immediate vesting.
Flexible working environment.
Paid time off, including vacation, sick leave, and paid holidays.
Employee Assistance Program with professional counseling, referrals, and additional services.
Paid maternity and paternity leave.
Pet insurance.
Employee discounts on phone plans, car rentals, and computers.
Paid time off for philanthropic endeavors.
Necessary equipment provided for the fully remote position.