Stop Loss Analyst

Jobtailor

Connecticut

On-site

USD 60,000 - 90,000

Full time

14 days+

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Job summary

Jobtailor in Connecticut seeks a detail-oriented Stop Loss Reporting Specialist to monitor and manage reporting activity for assigned clients, analyze data from carriers and portals, and maintain stop loss analytics. You will ensure timely submissions and accurate data across multiple reporting dashboards.

Responsibilities include producing monthly, quarterly, and annual stop loss reporting, supporting renewal initiatives, and collaborating with carriers, TPAs, PBMs, and internal consultants to

Qualifications

High school diploma required.
Some college coursework preferred.
Must obtain and maintain 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 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.
Strong follow-through and escalation management 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.
Working knowledge of self-funded and stop loss arrangements.

Responsibilities

Monitor and manage all stop loss reporting activity for assigned clients.
Download and review reports from carrier, TPA, PBM, and stop loss carrier portals.
Analyze medical, pharmacy, eligibility, and stop loss claim data for self-funded clients.
Maintain stop loss tracking databases, reporting logs, and standardized analytics templates.
Coordinate required documentation and reporting submissions to stop loss carriers within contract timelines.
Follow up on pended or denied claims to ensure adjudication and reimbursement.
Coordinate with stop loss carriers, TPAs, PBMs, and internal consultants on reimbursement tracking and claim resolution.
Create and maintain client reporting, financial exhibits, and stop loss analytics.
Produce monthly, quarterly, and annual stop loss reporting.
Manage monthly claims dashboards for assigned clients.
Review high-cost claimant activity and provide month-over-month updates on claim costs, diagnoses, treatment, prognosis, and future exposure.
Validate data and proactively resolve discrepancies and reporting issues.
Support renewal, marketing, and strategic consulting initiatives with large claim summaries and reimbursement analyses.
Enhance stop loss monitoring workflows, reporting tools, and quality-control procedures.
Contribute to advanced claims analytics, trend analysis, cost-driver and utilization insights.
Build and maintain standardized dashboards and executive-level financial exhibits.
Support employer and employee contribution modeling and benefit-plan financial analysis.
Partner with internal teams to improve data integrity and streamline reporting.
Contribute to ad hoc analytical projects, anomaly detection, performance monitoring, cost-saving opportunities, and coverage-gap identification

Skills

Analytical skills

Problem-solving skills

Advanced Excel

Organizational skills

Communication skills

Attention to detail

Time management

Multitasking

Data validation

Reporting skills

Education

High school diploma

Some college coursework

Tools

Microsoft Office Suite

Agency Management Systems

Stop Loss Carrier Portals

TPA Portals

PBM Portals

Job description

Monitor and manage all stop loss reporting activity for assigned clients
Download and review reports from carrier, TPA, PBM, and stop loss carrier portals
Analyze medical, pharmacy, eligibility, and stop loss claim data for self-funded clients
Maintain stop loss tracking databases, reporting logs, and standardized analytics templates
Coordinate required documentation and reporting submissions to stop loss carriers within contract timelines
Follow up on pended or denied claims to ensure adjudication and reimbursement
Coordinate with stop loss carriers, TPAs, PBMs, and internal consultants on reimbursement tracking and claim resolution
Create and maintain client reporting, financial exhibits, and stop loss analytics
Produce monthly, quarterly, and annual stop loss reporting
Manage monthly claims dashboards for assigned clients
Review high-cost claimant activity and provide month-over-month updates on claim costs, diagnoses, treatment, prognosis, and future exposure
Validate data and proactively resolve discrepancies and reporting issues
Support renewal, marketing, and strategic consulting initiatives with large claim summaries and reimbursement analyses
Enhance stop loss monitoring workflows, reporting tools, and quality-control procedures
Contribute to advanced claims analytics, trend analysis, cost-driver and utilization insights
Build and maintain standardized dashboards and executive-level financial exhibits
Support employer and employee contribution modeling and benefit-plan financial analysis
Partner with internal teams to improve data integrity and streamline reporting
Contribute to ad hoc analytical projects, anomaly detection, performance monitoring, cost-saving opportunities, and coverage-gap identification

Requirements

High school diploma required
Some college level coursework preferred
Must obtain and maintain 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 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
Strong follow-through and escalation management skills
Experience working 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
Working knowledge and understanding of self-funded and stop loss arrangements

Core Competencies

Demonstrates expertise in stop loss administration, claims analysis, and financial reporting, with a strong focus on data integrity and analytical problem-solving. Proficient in managing multiple deadlines and enhancing reporting workflows to support strategic initiatives.

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