Stop-Loss Risk & Claims Analyst

Lucent Health; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

Lucent Health is seeking a Stop Loss Analyst to support underwriting and claims for self-funded health plans. You will evaluate large claims, track reimbursement trends, and ensure timely submissions, combining analytical rigor with knowledge of stop loss contracts.

Ideal candidates have a 2+ years background in stop loss claims or TPA operations, strong Excel/data analytics skills, and excellent communication to collaborate with Claims, Care Management, and Finance teams.

Qualifications

• Bachelor's degree or higher in a related field.
• 2+ years of experience in stop loss claims or TPA operations.
• Strong working knowledge of self-funded health plans and stop loss contracts.
• Advanced Excel skills; proficiency in data analytics tools a plus.
• Exceptional attention to detail and organizational skills.
• Excellent communication and relationship management abilities.

Responsibilities

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

Skills

Stop loss claims

TPA operations

Data analytics

Excel

Communication

Education

Bachelor's degree in Business, Finance, Health Administration, or related field

Tools

LuminX

QicLink

Job description

Lucent Health is seeking a Stop Loss Analyst to support underwriting and claims for self-funded health plans. You will evaluate large claims, track reimbursement trends, and ensure timely submissions, combining analytical rigor with knowledge of stop loss contracts.

Ideal candidates have a 2+ years background in stop loss claims or TPA operations, strong Excel/data analytics skills, and excellent communication to collaborate with Claims, Care Management, and Finance teams.