Stop-Loss Claims Manager: Lead Adjudication & Analysis

HUB International; Atlanta (GA); Hybrid; USD 50,000 - 55,000; Full time

Job summary

HUB International is seeking a Stop‑Loss Claims Manager to oversee administration, adjudication, and resolution of high‑cost stop‑loss claims. You will liaise with employers, TPAs, brokers, and carriers to protect client interests and ensure compliant, timely processing.

Lead a team of claims analysts, mentor staff, and drive process improvements while maintaining strong stakeholder relationships. The role combines technical claims knowledge with analytical acumen in a dynamic environment.

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 5+ years in stop‑loss/medical/health claims with 2+ years in a supervisory role.
• Knowledge of self-funded health plans, stop‑loss contracts, and adjudication processes.
• Strong medical terminology, ICD/CPT coding, and U&C reimbursement understanding.
• Working knowledge of ERISA, HIPAA, ACA, and related regulations.
• Proficiency in claims systems and MS Office (Excel preferred).
• Excellent analytical, organizational, and decision‑making skills.
• Strong written and verbal communication with cross‑stakeholder influence.

Responsibilities

• Review, evaluate, and adjudicate stop‑loss claims per policy and regulatory requirements.
• Analyze submissions and medical records to verify eligibility and reimbursement amounts.
• Coordinate with employers, TPAs, brokers, and carriers to resolve issues.
• Monitor high‑dollar claims near deductibles and manage catastrophic cases.
• Ensure compliance with ERISA/HIPAA/ACA and internal policies.
• Prepare and present loss runs, trend analyses, and reports for leadership.
• Identify workflow improvements to reduce turnaround times.
• Investigate disputed claims and escalate with legal/clinical teams as needed.
• Oversee vendor relationships with reinsurers and cost‑containment providers.
• Mentor and supervise junior staff; provide technical guidance.

Skills

Stop-loss claims knowledge

Analytical skills

Communication skills

Regulatory understanding

Leadership

Education

Bachelor's degree in Business/Insurance/Risk Management/Healthcare Administration

Tools

Claims management systems

Microsoft Excel

Job description

HUB International is seeking a Stop‑Loss Claims Manager to oversee administration, adjudication, and resolution of high‑cost stop‑loss claims. You will liaise with employers, TPAs, brokers, and carriers to protect client interests and ensure compliant, timely processing.

Lead a team of claims analysts, mentor staff, and drive process improvements while maintaining strong stakeholder relationships. The role combines technical claims knowledge with analytical acumen in a dynamic environment.