Stop Loss Operations Specialist
New
J
JobgetherStop loss insurance
The position is fully remote and open to candidates residing in the United States.Full-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- At least 3 years of professional experience in insurance operations, premium administration, accounting, financial reconciliation, policy administration, or a related field.
- Required Skills
- Microsoft ExcelHIPAA
Requirements
- Have at least 3 years of professional experience in insurance operations, premium administration, accounting, financial reconciliation, policy administration, or a related field.
- Have working knowledge of self-funded medical plans, employer stop loss insurance terminology, insurance contracts, and related operational processes.
- Demonstrate strong analytical and reconciliation skills when managing premium, enrollment, policy, and financial data.
- Be able to interpret insurance policy provisions and underwriting terms, identify discrepancies, and determine when to escalate for review.
- Have experience managing financial or administrative processes with established controls, documentation standards, and recurring deadlines.
- Be proficient in Microsoft Office, particularly Excel and Word, and able to learn specialized insurance administration, underwriting, and reporting platforms.
- Be organized and able to manage multiple workflows, competing priorities, and assigned responsibilities independently.
- Be able to collaborate with insurance carriers, TPAs, producers, and internal Finance, Underwriting, and Claims teams.
- Have strong problem-solving skills, sound judgment, and attention to detail.
- Be able to work remotely with a quiet, secure workspace, reliable internet, and compliance with technology and information security requirements, including VPN usage and approved devices and software.
- Be based in the United States and able to comply with applicable data privacy and healthcare regulations, including HIPAA.
- Preferred: Bachelor's degree in Accounting, Finance, Business Administration, Insurance, or a related discipline.
Responsibilities
- Manage premium administration, policy issuance, licensing, reconciliations, and operational controls for the stop loss program.
- Process premium receipts, lockbox transactions, ACH payments, commissions, return premiums, and other financial activities.
- Reconcile enrollment records, expected premiums, and received payments; investigate and resolve financial discrepancies.
- Prepare monthly reconciliations and support month-end closing, carrier bordereaux, financial reporting, and program reports.
- Administer policies after underwriting approval, prepare policy documents, and verify terms against approved underwriting provisions.
- Coordinate agency and producer licensing, carrier appointments, renewals, and regulatory documentation.
- Maintain procedures, exception reports, internal controls, supporting records, and audit documentation.
- Support internal, financial, and carrier audits and ensure discrepancies and exceptions are documented and resolved.
- Coordinate workflows with Stop Loss Specialists and internal teams, escalating significant issues to leadership.
- Recommend improvements to operational processes, systems, reporting, and controls.
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