Stop Loss Analyst
$72,000–$72,000 year
HybridCranston, Rhode Island, United States or Canton, Massachusetts, United States
Job Summary
Monitor and manage all stop loss reporting activity for assigned clients by downloading, reviewing, and analyzing medical, pharmacy, eligibility, and claim data from carrier, TPA, and PBM portals. Maintain tracking databases and standardized analytics templates to coordinate documentation submissions and follow up persistently on pended or denied claims. Produce monthly, quarterly, and annual reports summarizing reimbursement status, catastrophic claims, and financial exposure, while managing claims dashboards and validating data for accuracy. Identify discrepancies, resolve reporting issues, and support renewal initiatives through large claim summaries and cost-driver analyses. Assist in developing internal monitoring workflows and contributing to advanced claims analytics across medical, pharmacy, and dental benefits.
Required Qualifications
- High school diploma
- Active Life/Accident and Health Insurance Agent License
- Two to five years of experience in employee benefits, stop loss administration, carrier operations, claims analysis, or related field
Desired Qualifications
- Some college level coursework
- Experience working with stop loss carriers, TPAs, PBMs, or self-funded plans
- Understanding of large claim reporting and reimbursement processes
- Strong analytical and problem-solving skills
- Advanced Excel and reporting skills
- Excellent organizational and tracking abilities with strong attention to detail
- Ability to manage multiple deadlines and prioritize time-sensitive issues
- Excellent oral and written communication skills
- Strong follow-through and escalation management skills
- Proficient in Microsoft Office Suite and Agency Management Systems
- Working knowledge and understanding of self-funded and stop loss arrangements
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