Stop-Loss Claims Analyst | Data-Driven Risk Management

Lucent Health Solutions LLC; Nashville (TN); On-site; USD 70,000 - 95,000; Full time

Job summary

Lucent Health is seeking a Stop Loss Analyst to manage financial risk for self-funded health plans, evaluating large claims, monitoring reimbursements, and supporting timely submissions across claims and finance teams.

Bachelor's degree in Business/Finance/Health Administration recommended; 2+ years stop loss/TPA experience; advanced Excel and data analytics skills; strong attention to detail and organization.

Qualifications

• Bachelor's degree preferred in business, finance, health administration or related field.
• 2+ years of stop loss claims or TPA operations experience.
• Strong knowledge of self-funded health plans and stop loss contracts.
• Advanced Excel; data analytics tools a plus.

Responsibilities

• Evaluate large medical and pharmacy claims for stop loss reimbursement eligibility.
• Assist in preparation and submission of stop loss claims to carriers, ensuring contract compliance.
• Monitor reimbursements and maintain status updates on pending claims.
• Collaborate with Claims, Care Management, and Finance to gather documentation.
• Liaise with stop loss carriers to resolve claim issues and provide support.
• Maintain detailed records in accordance with regulatory and HIPAA standards.
• Identify process inefficiencies and recommend improvements to optimize claims cycle time.

Skills

Advanced Excel

Data analytics

Attention to detail

Communication

Education

Bachelor's degree in Business/Finance/Health Administration

Tools

LuminX

QicLink

Job description

Lucent Health is seeking a Stop Loss Analyst to manage financial risk for self-funded health plans, evaluating large claims, monitoring reimbursements, and supporting timely submissions across claims and finance teams.

Bachelor's degree in Business/Finance/Health Administration recommended; 2+ years stop loss/TPA experience; advanced Excel and data analytics skills; strong attention to detail and organization.