Senior Stop Loss Consultant
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Job Description
Senior Stop Loss Consultant managing stop-loss placements and client consulting for healthcare plans. Overseeing implementation, claims monitoring, and team collaboration to enhance operational efficiency.
Responsibilities:
- Lead or support the full stop-loss placement process: data collection, market submissions, quote analysis, and recommendation.
- Negotiate stop-loss contracts and renewals directly with carriers to ensure optimal pricing, terms, and coverage structures.
- Serve as a stop-loss lead on new business opportunities and client transitions from fully insured to self-funded arrangements.
- Oversee the stop-loss implementation process in coordination with TPAs and carrier partners, ensuring policies are issued accurately and on time.
- Review and reconcile contracts, disclosures, ASO provisions, and reimbursement terms for alignment and accuracy.
- Monitor large claims activity and work closely with TPAs and carriers to support timely reimbursement submissions and payments.
- Manage a portion of the stop-loss book, including strategic guidance on renewals, plan design, captives, lasers, and risk mitigation strategies.
- Help direct and manage workflow for junior team members or peers as assigned, ensuring timely, accurate delivery of client work.
- Contribute to the development of standardized templates, reporting tools, and documentation procedures to improve efficiency and scale.
Requirements:
- Bachelor’s degree in Business Administration, Risk Management, Healthcare Administration, or related field
- Minimum of 7 years in employee benefits, with at least 5 years of direct stop-loss consulting, underwriting, or carrier negotiation experience
- Experience with a mix of fully insured, level-funded, and self-funded plans across multiple funding structures (ASO, minimum premium, captives)
- Familiarity with TPA models, ASO contract structures, and reimbursement mechanisms
- Ability to interpret and explain stop-loss terms, underwriting decisions, and claim adjudication policies to internal and external stakeholders
- Experience working with stop-loss platforms (e.g., Claros, Ringmaster) preferred
- Proficiency in Excel, PowerPoint, and internal reporting tools
- Current state insurance license (or ability to obtain within 90 days of hire)
Benefits:
- Equal Opportunity Employer
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