A&H Senior Claims Cost Containment Analyst

About the role

Join Westfield Specialty’s newest team! Westfield Specialty’s new A&H team has an opening for joining our expanding operation. As a key contributor on this highly experienced team, you'll help build a premier A&H reinsurance and insurance operation. This new team offers significant opportunities for career growth and development.

Responsibilities

• Assist with the day-to-day activities of the A&H reinsurance and stop loss claims function, from first notice through resolution.
• Provide exceptional customer service through all interactions and communications with internal and external business partners.
• Collaborate with management team on cost containment and claims operations.
• Act as a primary point of contact for cost containment vendors (e.g., PPO networks, bill review, clinical management, specialty vendors).
• Cook up cost containment workflows to support stop loss and reinsurance claims outcomes.
• Monitor vendor performance, turnaround times, and effectiveness; escalate issues as needed.
• Aid in evaluating cost containment opportunities and process improvements.
• Aid in reviewing, processing, and adjudicating stop loss and reinsurance claims in accordance with policy provisions and regulatory requirements.
• Aid in developing and refining workflows, checklists, and best practices for stop loss claims and cost containment.
• Contribute to training, knowledge sharing, and process documentation.
• Support special projects related to claims operations, reinsurance reporting, or vendor initiatives.

Requirements

Successful candidates will have a strong knowledge of healthcare insurance policies, procedures, and regulations.

Qualifications

• Bachelor’s degree or equivalent experience.
• 3–7 years of experience in stop loss claims, A&H claims, or reinsurance-related roles.
• Strong working knowledge of stop loss policy provisions and claims adjudication.
• Experience working with cost containment vendors and/or TPAs.
• Ability to manage multiple priorities in a high-volume, deadline-driven environment.
• Strong communication skills with the ability to interact confidently with internal and external partners.
• Excellent written, verbal, and interpersonal communication skills.
• Strong analytic, investigative, listening, and negotiation skills.
• A desire to be part of a new and growing team.
• Keen attention to detail.
• Ability to work independently.
• Demonstrated problem solving ability.

Skills

• Bachelor’s degree or equivalent experience.
• 3–7 years of experience in stop loss claims, A&H claims, or reinsurance-related roles.
• Strong working knowledge of stop loss policy provisions and claims adjudication.
• Experience working with cost containment vendors and/or TPAs.
• Ability to manage multiple priorities in a high-volume, deadline-driven environment.
• Strong communication skills with the ability to interact confidently with internal and external partners.
• Excellent written, verbal, and interpersonal communication skills.
• Strong analytic, investigative, listening, and negotiation skills.
• A desire to be part of a new and growing team.
• Keen attention to detail.
• Ability to work independently.
• Demonstrated problem solving ability.