Hybrid Stop-Loss Analytics Specialist

CEB Cranston EB; Canton (MA); Hybrid; USD 65,000 - 79,000; Full time

Benefits offered by this job

Life Insurance

Short-Term Disability

Long-Term Disability

Medical/Dental/Vision

401(k) with company match

Paid Time Off

Job summary

Hilb Group is seeking a motivated Stop Loss Analyst to join our team in a hybrid role serving clients across multiple locations, including Canton, MA. You will monitor stop loss reporting, review carrier portals, and analyze claims data to support self-funded plans and reimbursements.

The role requires strong analytical and Excel skills, excellent organization, and the ability to manage multiple deadlines while maintaining clear communication with carriers and internal teams.

Qualifications

• High school diploma required; some college coursework preferred.
• Active Life/Accident and Health Insurance Agent License required.
• 2–5 years of experience in employee benefits, stop loss administration, carrier operations, claims analysis, or related field preferred.
• 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.
• Experience with stop loss carriers, TPAs, PBMs, or self-funded plans preferred.
• Understanding of large claim reporting and reimbursement processes preferred.
• Proficient in Microsoft Office Suite and Agency Management Systems.

Responsibilities

• Monitor and manage stop loss reporting activity for assigned clients.
• Download and review reports from carrier, TPA, PBM portals.
• Analyze medical, pharmacy, eligibility, and stop loss claim data for self-funded clients.
• Maintain stop loss tracking databases, reporting logs, and analytics templates.
• Coordinate submission of documentation to stop loss carriers within contract timelines.
• Follow up on pended or denied claims to ensure adjudication and reimbursement.
• Coordinate with carriers, TPAs, PBMs, and consultants on reimbursement tracking and claim resolution.
• Ensure prescription drug claim details are captured in stop loss reporting.
• Create and maintain standardized client reporting and financial exhibits.
• Produce monthly/quarterly/annual stop loss reporting summarizing reimbursement status and exposure.
• Maintain monthly claims dashboards for assigned clients.
• Review high-cost claimant activity and provide month-over-month cost updates.
• Validate data from TPAs, PBMs, carriers, and vendors for accuracy.
• Identify discrepancies and resolve reporting issues.
• Support renewal, marketing, and strategic consulting with large claim summaries.

Skills

Analytical thinking

Problem solving

Advanced Excel

Reporting skills

Organizational skills

Communication skills

Deadline management

Attention to detail

Education

High school diploma

Some college coursework preferred

Tools

Agency Management Systems

Microsoft Office Suite

Job description

Hilb Group is seeking a motivated Stop Loss Analyst to join our team in a hybrid role serving clients across multiple locations, including Canton, MA. You will monitor stop loss reporting, review carrier portals, and analyze claims data to support self-funded plans and reimbursements.

The role requires strong analytical and Excel skills, excellent organization, and the ability to manage multiple deadlines while maintaining clear communication with carriers and internal teams.