What are the responsibilities and job description for the Stop Loss Consultant position at Higginbotham?
The Stop Loss Consultant plays a key role in supporting the placement, implementation, and ongoing servicing of stop-loss coverage for self-funded employer groups. This position is focused on the hands-on execution of quoting, data analysis, implementation tracking, and claims reimbursement coordination.
This is an ideal role for a technically skilled, detail-oriented professional who understands stop-loss and self-funding and is ready to take ownership of their book of work within a supportive and collaborative team.
Key Responsibilities
Stop-Loss Placement & Renewal Support
- Gather and validate data for stop-loss marketing, including census, claims, and plan documents.
- Prepare quote requests and submit to stop-loss carriers; track responses and compile results.
- Support review and analysis of stop-loss proposals; prepare summaries and recommendations for client-facing account teams.
- Assist in the negotiation of renewal terms by providing documentation, experience data, and historical comparisons.
Implementation & Contracting Coordination
- Coordinate with TPAs and carriers on the execution of new and renewal stop-loss policies.
- Ensure timely delivery and accuracy of policy documents, disclosures, and ASO agreements.
- Track open implementation items and escalate delays or inconsistencies to the Senior Stop Loss Consultant.
Claims & Reimbursement Process
- Monitor large claim activity and support timely and complete reimbursement submission.
- Track claim reimbursement status, follow up with TPAs and carriers, and escalate delayed payments or disputes.
- Maintain internal logs and documentation of open and resolved reimbursement issues.
Client & Internal Team Support
- Prepare client deliverables, including market summaries, reimbursement trackers, and experience reports.
- Attend client meetings as needed with account managers or senior consultants to support stop-loss discussions.
- Help troubleshoot client and carrier issues and coordinate across internal teams to ensure resolution.
Practice Collaboration
- Contribute to standardizing workflows, templates, and internal documentation processes.
- Participate in internal training, market updates, and process improvement initiatives.
- Stay up to date on carrier updates, market trends, and regulatory shifts that impact stop-loss strategy.
Qualifications
- Education: Bachelor’s degree in Business, Healthcare, Risk Management, or a related field. Equivalent experience may be considered.
- Experience: 3–5 years of experience in stop-loss consulting, underwriting, TPA stop-loss coordination, or benefits administration with exposure to self-funded plans.
- Understanding of stop-loss coverage types, contract terms, and claim eligibility rules.
- Proficiency in Microsoft Excel; ability to manipulate and summarize data effectively.
- Excellent attention to detail, task follow-through, and time management.
- Clear and professional written and verbal communication skills.
- Experience using quoting platforms (e.g., Ringmaster, Claros) a plus but not required.
- Willingness to pursue state insurance licensure if not currently licensed.
