Stop Loss Analyst

Monitor and manage all stop loss reporting activity for assigned clients
Download and review reports from carrier, TPA, PBM, and stop loss carrier portals
Analyze medical, pharmacy, eligibility, and stop loss claim data for self-funded clients
Maintain stop loss tracking databases, reporting logs, and standardized analytics templates
Coordinate required documentation and reporting submissions to stop loss carriers within contract timelines
Follow up on pended or denied claims to ensure adjudication and reimbursement
Coordinate with stop loss carriers, TPAs, PBMs, and internal consultants on reimbursement tracking and claim resolution
Create and maintain client reporting, financial exhibits, and stop loss analytics
Produce monthly, quarterly, and annual stop loss reporting
Manage monthly claims dashboards for assigned clients
Review high-cost claimant activity and provide month-over-month updates on claim costs, diagnoses, treatment, prognosis, and future exposure
Validate data and proactively resolve discrepancies and reporting issues
Support renewal, marketing, and strategic consulting initiatives with large claim summaries and reimbursement analyses
Enhance stop loss monitoring workflows, reporting tools, and quality-control procedures
Contribute to advanced claims analytics, trend analysis, cost-driver and utilization insights
Build and maintain standardized dashboards and executive-level financial exhibits
Support employer and employee contribution modeling and benefit-plan financial analysis
Partner with internal teams to improve data integrity and streamline reporting
Contribute to ad hoc analytical projects, anomaly detection, performance monitoring, cost-saving opportunities, and coverage-gap identification

• High school diploma required
• Some college level coursework preferred
• Must obtain and maintain active Life/Accident and Health Insurance Agent License
• Two to five years of experience in employee benefits, stop loss administration, carrier operations, claims analysis, or related field preferred
• Strong analytical and problem-solving skills
• Advanced Excel and reporting skills
• Excellent organizational and tracking abilities with strong attention to detail
• Ability to manage multiple deadlines and prioritize time-sensitive issues
• Excellent oral and written communication skills
• Strong follow-through and escalation management skills
• Experience working with stop loss carriers, TPAs, PBMs, or self-funded plans preferred
• Understanding of large claim reporting and reimbursement processes preferred
• Proficient in Microsoft Office Suite and Agency Management Systems
• Working knowledge and understanding of self-funded and stop loss arrangements

Demonstrates expertise in stop loss administration, claims analysis, and financial reporting, with a strong focus on data integrity and analytical problem-solving. Proficient in managing multiple deadlines and enhancing reporting workflows to support strategic initiatives.

• Stop Loss Administration
• Claims Analysis
• Advanced Excel Skills
• Life/Accident and Health Insurance Agent License
• Data Integrity Management

• Claims Analysis
• Stop Loss Administration
• Data Validation
• Trend Analysis
• Financial Reporting
• Reimbursement Processes
• Anomaly Detection
• Cost-Saving Opportunities
• Eligibility Analysis
• Reporting Skills

• Analytical Skills
• Problem-Solving Skills
• Organizational Skills
• Attention to Detail
• Communication Skills

• Life/Accident and Health Insurance Agent License

• Self-Funded Plans
• Stop Loss Arrangements
• Employee Benefits
• Carrier Operations
• High-Cost Claim Reporting

• Microsoft Office Suite
• Agency Management Systems
• Stop Loss Carrier Portals
• TPA Portals
• PBM Portals