Stop Loss Claims Analyst | Reimbursement & Audit

Lucent Health; Nashville (TN); On-site; USD 55,000 - 75,000; Full time

Job summary

Lucent Health in Nashville, TN is seeking a Stop Loss Analyst to support administration, monitoring, and reimbursement recovery of stop loss claims for self-funded employer groups. You will identify high-cost claimants, audit eligibility, prepare submissions, and maintain documentation to ensure timely recovery and compliance with policy requirements.

This role requires collaboration with carriers, brokers, account management, underwriting, and client service teams, along with strong data

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• 1–3 years of stop loss, medical claims, benefits administration, or related experience.
• Working knowledge of self-funded health plans and stop loss concepts.
• Ability to review claim detail reporting and reconcile data.
• Proficiency with Outlook, Word, and Excel.
• Strong attention to detail, organization, and communication.
• Ability to manage multiple priorities in a fast-paced TPA environment.
• Commitment to confidentiality and client service.

Responsibilities

• Monitor claim activity and identify members approaching or exceeding deductible thresholds and high-cost claimants.
• Review paid medical and pharmacy claims, eligibility records, plan documents, and stop loss policy provisions for eligibility and accuracy.
• Prepare and submit complete reimbursement requests to stop loss carriers with supporting documentation.
• Track pending, outstanding, reimbursed, denied, and pended claims; coordinate with carriers and internal teams to resolve items.
• Process reimbursement payments from stop loss carriers and coordinate with accounting and claims teams.
• Support monthly and year-end aggregate reporting, accommodation requests, and claim reconciliations.
• Serve as liaison between internal teams, stop loss carriers, brokers, account management, underwriting, and clients.
• Maintain accurate electronic claim files, tracking logs, and audit-ready documentation.
• Assist with audits, quality reviews, renewal analysis, and data/trend insights for clients.
• Identify process gaps and recommend improvements to enhance efficiency and service.

Skills

Stop loss knowledge

Claims analysis

Healthcare operations

Data reconciliation

Attention to detail

Communication skills

Multitasking

Education

High school diploma or equivalent

Associate or bachelor’s degree in business, healthcare administration, finance, accounting, or a related field

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Lucent Health in Nashville, TN is seeking a Stop Loss Analyst to support administration, monitoring, and reimbursement recovery of stop loss claims for self-funded employer groups. You will identify high-cost claimants, audit eligibility, prepare submissions, and maintain documentation to ensure timely recovery and compliance with policy requirements.

This role requires collaboration with carriers, brokers, account management, underwriting, and client service teams, along with strong data