Medical Stop Loss Claims Group Insurance (Remote)

Responsibilities

• Develop and execute the vision and strategy for the Stop Loss Claims function
• Establish scalable workflows and best practices to enhance operational excellence
• Design and optimize claims technology solutions and ensure efficiency
• Lead a high-performing claims team focused on accountability and improvement
• Review and approve complex medical stop loss claims for accuracy
• Build relationships with brokers, TPAs, and internal stakeholders to strengthen business operations
• Utilize data analytics to drive process improvements and enhance service delivery
• Ensure compliance with applicable regulations and internal controls

Qualifications

• 10+ years of experience in group insurance claims with a focus on medical stop loss claims
• In-depth knowledge of stop loss claim adjudication, reimbursement practices, and policy interpretation
• Demonstrated leadership experience in operational transformation within a growing organization
• Strong understanding of medical terminology, and relevant coding systems (CPT/HCPCS/ICD-10)
• Proficient in Microsoft Office suite, especially Excel and PowerPoint
• Effective communication, executive presence, and stakeholder management skills
• Ability to foster growth and structure in a dynamic business environment

Benefits

• Market competitive base salaries with yearly bonus potential
• Comprehensive medical, dental, and vision insurance, along with life and disability insurance
• Generous Paid Time Off (PTO) and leave policies including parental leave
• 401(k) plan with company match and a company-funded pension
• Wellness reimbursement program up to $1,600 per year for personal wellbeing
• Work/Life Resources to support various personal and professional needs