We are currently looking for an Stop Loss Healthcare Analyst for an established claims adjusting and actuarial service organization based in Irving, TX. Incredible leadership and an excellent opportunity to join a well-established, collaborative, and growth-focused organization.
This position requires proficiency in evaluating claims data, financial reports, and the performance of stop-loss policies. Strong communication skills, both written and verbal, are essential, as is advanced proficiency in Excel. Familiarity with the structure, pricing, and regulations surrounding stop-loss insurance is crucial.
Key Responsibilities:
- Assess risk for self-funded and level-funded health insurance programs, offering accurate evaluations and recommendations.
- Analyze stop-loss coverage options (individual and aggregate) to assist in managing potential risks for employer-sponsored health plans.
- Review healthcare claims data and financial reports, identifying trends and offering actionable insights to enhance risk management strategies.
- Generate and analyze claims reports, loss ratio data, and other key metrics to support underwriting decisions.
- Work closely with underwriting and actuarial teams to create accurate stop-loss pricing models and risk assessments.
- Interpret and manage stop-loss insurance contracts, including policy terms, coverage limits, and conditions.
- Stay updated on industry regulations and emerging trends related to stop-loss insurance and healthcare plans.
- Document findings and recommendations in clear, concise reports for internal and external stakeholders.
- Assist with stop-loss policy renewals by providing up-to-date claims and risk analysis.
- Resolve issues related to claims, policy interpretation, or disputes regarding coverage.
- Ensure precise handling of policy details, claims, and financial calculations to maintain accurate coverage.
Qualifications:
- Bachelor’s degree in Finance, Actuarial Science, Business, Healthcare Administration, or related field, or equivalent work experience.
- 3-5 years of experience in group insurance, underwriting, or stop-loss analysis.
- Strong knowledge of self-funded and level-funded health insurance, including stop-loss insurance for individual and aggregate risks.
- Proficiency in analyzing claims data, financial reports, and insurance performance metrics.
- Advanced Excel skills and experience with data analysis tools (e.g., SQL or similar).
- Exceptional analytical abilities, with a focus on identifying trends, assessing risk, and evaluating stop-loss options.
- Excellent written and verbal communication skills for documenting and presenting complex analyses.
- Strong understanding of insurance products, industry regulations, and compliance requirements relevant to stop-loss insurance and health plans.
- Problem-solving abilities for resolving claims disputes, policy interpretation issues, and coverage challenges.
Preferred Qualifications:
- Experience working with self-funded employers or stop-loss carriers.
- Knowledge of compliance and regulatory requirements for self-funded or level-funded insurance programs.
- Progress toward actuarial certification or actuarial experience is a plus.
This role offers the opportunity to contribute to a fast-paced team, helping to manage the risks associated with group health insurance plans. If you're passionate about healthcare claims analysis, stop-loss underwriting, and risk management, we encourage you to apply!
