Stop Loss Claims Manager

Location: Northern

Stop Loss Claims Manager page is loaded## Stop Loss Claims Manager remote type:
Hybrid Working locations:
Atlanta, GAtime type:
Full time posted on:
Publicado hoyjob requisition : R0038932
** A path for every ambition.
** At HUB, we believe the best work happens when people are given real space to grow and then given the autonomy to exercise it. We power progress and protect ambition: for the clients who count on us, and equally for the people who make that possible every day.

We're creative thinkers and determined doers, guided by values that show up in how we work together: with empathy, adaptability, accountability and a genuine commitment to one another's success. We foster bold ideas, celebrate curiosity and share what we know. Because when people grow, the work they do grows with them.

Our purpose is deeply human: to help people navigate the world on their terms, at their speed, toward their future. We hold that same commitment to the people building careers here.

Whether you're starting out or leveling up, you'll find the resources to evolve, the support to take on more and a team ready to back you at every stage.

Your ambition has a home here.
** About SPG:
** Specialty Program Group (SPG) is the wholesale & MGA division of HUB International (5th Largest Global Broker). SPG acts in a holding company capacity acquiring best in class underwriting businesses to operate independently under discrete brands (portfolio companies).Strategic Benefit Resources provides complete facilitation of specific and aggregate stop loss claims. Our comprehensive approach begins with a thorough review of the claims submission and ends with an expedited and accurate reimbursement.##

Position Summary The Stop-Loss Claims Manager oversees the administration, adjudication, and resolution of stop-loss insurance claims, ensuring accuracy, compliance, and timely processing. This role serves as a critical liaison between employers, third-party administrators (TPAs), brokers, and carriers, managing high-cost claims that exceed predetermined thresholds.

The successful candidate combines deep technical claims knowledge with strong communication and analytical skills to protect organizational interests while maintaining strong relationships across all stakeholders.##

Key Responsibilities
* ** Claims Administration & Adjudication:
** Review, evaluate, and adjudicate specific and aggregate stop-loss claims in accordance with policy provisions, contractual terms, and regulatory requirements.
* ** Documentation & Verification:
** Analyze claim submissions, medical records, and supporting documentation to validate eligibility, accuracy, and reimbursement amounts.
* ** Stakeholder Liaison:
** Serve as the primary point of contact between employers, TPAs, brokers, and carriers to facilitate clear communication and expedite claim resolution.
* ** High-Cost Claim Management:
** Monitor claims approaching or exceeding specific deductible thresholds; proactively flag, track, and manage catastrophic and trigger-diagnosis cases.
* ** Compliance Oversight:
** Ensure all claims handling adheres to applicable federal and state regulations (ERISA, HIPAA, ACA) and internal policies.
* ** Reporting & Analytics:
** Prepare and present claims reports, loss runs, and trend analyses for internal leadership and external partners; identify cost-driver patterns and recommend mitigation strategies.
* ** Process Improvement:
** Identify opportunities to streamline workflows, reduce turnaround times, and enhance claim handling quality.
* ** Dispute Resolution:
** Investigate and resolve disputed, denied, or contested claims, coordinating with legal and clinical resources when escalation is required.
* ** Vendor Management:
** Oversee relationships with reinsurers,…