Stop Loss Claims Analyst

Stop Loss Claims Analyst – Cambia Health Solutions

Work from home within Oregon, Washington, Idaho, or Utah.

As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws, and regulations – all in service of creating a person‑focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

High School Diploma or GED with 5 years of professional claims processing experience, or an equivalent combination of education and experience.

• Knowledge of when to utilize legal and clinical resources to comprehend terminology in order to make final determinations on whether to approve or further investigate a claim.
• Strong knowledge of policy and contract terms, including deduplication and aggregate deductible calculations to ensure correct processing of all eligible claim reimbursements.
• Advanced knowledge of claim reserving and settlement.
• Excellent communication skills for both external and internal customers.
• Demonstrated understanding of medical terminology and ICD‑10/CPT coding.
• Experience with AI tools and technologies to enhance productivity and decision‑making in professional settings is highly desired.

• Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims; reference applicable policies and procedures quickly.
• Make informed decisions regarding the disposition of a claim, including payment, denial, or request for further information.
• Lead the process to measure, track, and report all aggregate claims.
• Audit all aggregate claims onsite and off‑site when needed based on set dollar thresholds and provide client audit reporting as required.
• Manage inventory of claims while ensuring best practices and claim standards are met.
• Identify new opportunities to track and process claims more efficiently; document claims throughout the adjudication process for audit purposes.
• Analyze and investigate all claims, request supplemental documentation as necessary, to process or reprocess claims promptly and accurately.

• No unusual working conditions.
• Work is primarily performed in an office environment.

Expected hiring range: $68,900.00 – $93,150.00, depending on skills, experience, education, and training; bonus target 10%. Current full salary range: $64,000.00 – $.

Benefits include medical, dental, vision coverage for employees and eligible family members (including mental health benefits), annual employer contribution to a health savings account, generous paid time off, 10 company‑paid holidays, market‑leading retirement plan with 401(k) match and potential discretionary contribution based on company performance, up to 12 weeks of paid parental time off (after 12 months continuous service), award‑winning wellness programs, employee assistance fund, and commute and parking benefits.

We are an Equal Opportunity employer dedicated to a drug and tobacco‑free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status, or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email C

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