Reinsurance Specialist

About Us

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

About the Role

The Reinsurance Specialist will report to the Director of Underwriting. This role ensures accurate, timely stop-loss premium, claims, reimbursement, and payment data for the health plan’s Self-funded accounts, including reinsurance and LMF products, by validating monthly sources and resolving variances with cross-functional teams and vendors. The Specialist manages reinsurance inquiries via a centralized mailbox, maintains clear documentation and standard operating procedures (SOPs) for decisions and issue resolution, and supports compliance and close activities.

Responsibilities

• Stop-Loss Management
  • Review reinsurance payment details for accuracy, completeness, and timeliness.
  • Review and validate premium, claims, and reimbursement data to confirm alignment and quality across sources (monthly).
  • Identify variances, investigate root causes, and coordinate resolution with the appropriate teams.
  • Ensure stop-loss policy filings are prepared, submitted, tracked, and kept compliant/approved with required regulators and internal governance.
• Settlement Payments
  • Partner with the Settlement Coordinator to support settlement/surplus reporting and related analyses.
  • Support month-end and period-end close activities, including required tie-outs and documentation.
• Communications & Inquiry Management
  • Establish and manage a reinsurance mailbox, respond to inquiries, and route issues (Finance, Claims, Sales, etc.).
  • Maintain documentation of decisions, resolutions, and standard operating procedures (SOPs).
  • Support audit requests and reporting needs and ensure adherence to reinsurance agreement requirements.
• Key Performance Metrics
  • Reconciliation accuracy & timeliness: % of monthly premium/claims/reimbursement tie-outs completed on-time and accepted with no rework.
  • Stop-loss payment review quality: % of vendor payment details reviewed within SLA and error/variance rate identified (and prevented from posting).
  • Variance resolution cycle time: Average days to triage, root-cause, and close variances (including % closed within target SLA).
  • Compliance & audit readiness: % of required stop-loss filings submitted/approved by deadlines and audit request turnaround time (with complete support on first pass).

Requirements

• Education, Certification, and Licensure
  • Bachelor’s Degree (Mathematics, Statistics, Actuarial Science, Accounting, Finance, or other analytical discipline).
• Experience
  • 5-7 years’ experience in health plan finance/operations and/or claims finance.
  • Demonstrated experience supporting close cycles and working with external vendors.
  • Prior exposure to regulatory filing coordination.
  • Stop-loss (medical) reinsurance knowledge (policy terms, reimbursement mechanics, attachments/lasers, exclusions).
  • Level monthly funded product familiarity (how premiums, claims funding, and settlements flow).
  • Understanding of reinsurance agreement requirements and operational compliance obligations.
  • Familiarity with monthly data validation across sources, as well as financial reconciliations, tie-outs, and variance analysis.
  • Experience with root-cause analysis of data/process discrepancies.
  • Experience with SOP creation/maintenance and process documentation.
  • Experience with shared mailbox/work intake management and issue tracking.
• Skills
  • Well-developed verbal and written communication skills.
  • Ability to exercise sound judgment and raise issues to appropriate senior Underwriting leaders for resolution.
  • Proficiency with MS Office applications (Excel, Access, Word, PowerPoint).
  • Ability to work collaboratively as part of a team and effectively communicate with all internal departments in verbal and written formats.

Working Conditions

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.
• Must maintain confidential information/correspondence and meet extremely tight deadlines.

Pay

Salary Range: $68,440.00 - $102,660.00

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay.

Benefits

• Medical, dental, and vision coverage.
• Retirement plans.
• Paid time off.
• Employer-paid life and disability insurance with additional buy-up coverage options.
• Tuition program.
• Well-being benefits.
• Full suite of benefits to support career development, individual & family health, and financial health.

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/.