Health Insurance Stop Loss Analyst

Job Title: Health Insurance Stop Loss Analyst

Position Summary: We are seeking an experienced Health Insurance Stop Loss Analyst with a solid background in group insurance and underwriting. The ideal candidate will possess a deep understanding of stop loss coverage, strong analytical and risk management skills, and relevant industry experience. This role requires proficiency in analyzing claims data, financial reports, and stop loss insurance performance. Candidates must have the ability to communicate effectively, both in writing and verbally, and demonstrate strong Excel skills. Familiarity with stop loss insurance structures, pricing, and regulatory compliance is essential.

Key Responsibilities:

• Analyze risk associated with self-funded and level-funded health insurance programs, providing accurate assessments and recommendations.
• Evaluate stop-loss coverage options (both individual and aggregate) to help manage and mitigate potential risks for employer-sponsored health plans.
• Review and analyze healthcare claims data, financial reports, and stop loss insurance performance, identifying trends and providing actionable insights.
• Generate, review, and interpret claims reports, loss ratio reports, and other relevant data to support risk management strategies and underwriting decisions.
• Collaborate with underwriting and actuarial teams to develop accurate stop-loss pricing models and risk assessments.
• Interpret and manage stop loss insurance policies and contracts, including understanding terms, conditions, and coverage limits.
• Stay current with industry regulations, compliance requirements, and emerging risks related to stop-loss insurance and health plans.
• Provide clear, concise documentation of analysis, findings, and recommendations for both internal and external stakeholders.
• Assist in the renewal process for stop-loss contracts by providing updated claims and risk analysis.
• Address and resolve issues related to claims, policy interpretation, or coverage disputes.
• Maintain precision in managing policy details, claims processing, and financial calculations to ensure correct coverage.

Qualifications:

• Bachelor's degree in a related field (e.g., Finance, Actuarial Science, Business, Healthcare Administration) or equivalent experience.
• Minimum of 3-5 years of experience in group insurance, underwriting, or stop-loss analysis.
• Strong understanding of self-funded and level-funded health insurance programs, including stop-loss insurance (individual and aggregate).
• Proficiency in analyzing claims data, financial reports, and stop-loss insurance performance.
• Expertise in Excel, with advanced knowledge of data analysis tools and software (e.g., SQL or similar platforms).
• Strong analytical skills with a focus on identifying trends, assessing risk, and evaluating stop-loss insurance options.
• Excellent communication skills, with the ability to document and present complex analysis clearly and concisely.
• In-depth knowledge of insurance products, industry regulations, and compliance requirements related to stop loss insurance and health plans.
• Strong problem-solving skills to address and resolve claims issues, policy interpretation, and coverage disputes.

Preferred Qualifications:

• Experience working with self-funded employers or stop-loss carriers.
• Familiarity with regulatory and compliance requirements for self-funded and level-funded insurance programs.
• Actuarial background or progress towards actuarial certification is a plus.

This is an exciting opportunity for a skilled analyst to join a dynamic team, helping to manage and mitigate the risks associated with group health insurance plans. If you have a passion for healthcare claims analysis, stop-loss underwriting, and risk management, we encourage you to apply.