Reinsurance Specialist

Who We Are Point
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Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point
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Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are.

We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are  Summary The Reinsurance Specialist will report to the Director of Underwriting. The Reinsurance Specialist ensures accurate, timely stop-loss premium, claims, reimbursement, and payment data for the health plan’s Self-funded accounts including reinsurance and LMF product by validating monthly sources and resolving variances with cross-functional teams and the vendor.

They manage reinsurance inquiries via a centralized mailbox and maintain clear documentation and standard operating procedures (SOPs) for decisions and issue resolution. They also support compliance and close activities by coordinating stop-loss policy filings, settlement/ surplus reporting with the Settlement Coordinator, month/period-end tie-outs, and audit/reporting requirements aligned to reinsurance agreements.

The individual will need to be self-motivated with the ability to work independently and within a team environment with strong follow-up, organization/prioritization skills, and excellent attention to detail. The individual is required to maintain confidential information/correspondence and be responsible for meeting extremely tight deadlines.

Reinsurance Specialist should independently manage essential functions, teach those skills to staff, prioritize them and seek assistance from company UW management team members. These functions need to be performed on a consistent and regular basis, using strong judgment. Requires the ability to learn and apply all company Plan policies consistently. The Reinsurance Specialist is expected to seek guidance from Underwriting management when appropriate.

Additional responsibilities include developing and maintaining reports using various systems.

Job Description

Key Responsibilities /Duties – what you will be doing:

Stop-Loss Management Review reinsurance payment details for accuracy, completeness, and timeliness.

Review and validate premium, claims, and reimbursement data to confirm alignment and quality across sources (monthly)
Identify variances, investigate root causes, and coordinate resolution with the appropriate teams.

Ensures stop‑loss policy filings are prepared, submitted, tracked, and kept compliant/approved with required regulators and internal governance

Settlement Payments Partner with the Settlement Coordinator to support settlement/ surplus reporting and related analyses.

Support month-end and period-end close activities, including required tie-outs and documentation.

Communications & Inquiry Management Establish and manage reinsurance mailbox, respond to inquiries and route issues (Finance, Claims, Sales, etc.)Maintain documentation of decisions, resolutions, and standard operating procedures (SOPs)
Support audit requests and reporting needs and ensure adherence to reinsurance agreement requirements.

Reconciliation accuracy & timeliness: % of monthly premium/claims/reimbursement tie-outs completed on-time and accepted with no rework.

Stop-loss payment review quality: % of vendor payment details reviewed within SLA and error/variance rate identified (and prevented from posting).Variance resolution cycle time:
Average days to triage, root-cause, and close variances (including % closed within target SLA).Compliance…