Stop Loss Analyst

2 months ago

Irving, United States Thomas Watson Group Full time

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

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