Stop-Loss Claims Analyst & Reimbursement Specialist

Lucent Health Solutions; Nashville (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

Lucent Health 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 claim data, prepare reimbursement submissions, and maintain documentation for timely recovery and compliance with policy requirements.

You will monitor claim activity, review eligibility records and policy provisions, coordinate with carriers and internal teams, and ensure accurate

Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree in business, healthcare administration, finance, accounting, or related field preferred.
• 1–3 years of experience in stop loss, medical claims, benefits administration, healthcare operations, or related field preferred.
• Working knowledge of self-funded health plans, stop loss, claim funding, reimbursement processes, eligibility, and plan document requirements preferred.
• Ability to review medical and prescription drug claim detail reporting, interpret policy and plan provisions, reconcile data, and identify documentation needed to support reimbursement.
• Proficiency with Microsoft Outlook, Word, and Excel.
• Strong attention to detail, organization, follow-through, and analytical problem-solving skills.
• Clear written and verbal communication skills with the ability to collaborate across claims, account management, finance, underwriting, carriers, brokers, and clients.
• Ability to manage multiple priorities, meet deadlines, and work independently in a fast-paced TPA environment.
• Commitment to confidentiality, accuracy, compliance, and excellent service for clients and members.

Responsibilities

• Monitor claim activity to identify members approaching deductible thresholds and high-cost claimants.
• Review paid medical and pharmacy claims, fees, eligibility records, plan documents, and stop loss policy provisions for reimbursement eligibility.
• Prepare, organize, and submit complete reimbursement requests to stop loss carriers with all required documentation.
• Track pending, outstanding, reimbursed, denied, and pended claims; follow up with carriers, vendors, internal teams, and clients to resolve items.
• Process reimbursement payments from stop loss carriers and coordinate with accounting and claims teams for accurate application.
• Support monthly and year-end aggregate reporting, accommodation requests, and claim reconciliation processes.
• Serve as a liaison between internal TPA operations, stop loss carriers, brokers, account management, underwriting, and client-facing teams.
• Maintain accurate electronic claim files, tracking logs, reports, and audit-ready documentation.
• Assist with internal audits, quality reviews, renewal analysis, disclosure updates, and sales or implementation support by providing stop loss data and trend insights.
• Identify process gaps and improvements to enhance efficiency and client service.

Skills

Attention to detail

Analytical skills

Communication

Multi-tasking

Education

High school diploma

Healthcare/Business degree preferred

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

Lucent Health 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 claim data, prepare reimbursement submissions, and maintain documentation for timely recovery and compliance with policy requirements.

You will monitor claim activity, review eligibility records and policy provisions, coordinate with carriers and internal teams, and ensure accurate