Stop Loss Operations Specialist

Vālenz Health® is the destination for employers, brokers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience. Through advanced technology and clinical expertise, Valenz creates a distinctly different approach to a complex healthcare system. With our solutions, we execute across the entire healthcare journey — from member experience to payment integrity, provider quality, and plan performance. With one of America’s largest cost, quality and utilization datasets, we create greater transparency, flexibility, and cost containment — empowering members and employers with the information they need to make smarter, more cost-effective decisions. About This Opportunity: As a Stop Loss Operations Specialist(aka Stop Loss Operations Analyst), you’ll support the financial and administrative operations of our stop loss program, including premium administration, policy issuance, licensing, reconciliation, and operational controls. You’ll ensure transactions, policy documentation, and regulatory records are accurate, timely, and audit-ready while maintaining compliance with program requirements. You’ll also collaborate closely with Underwriting, Claims, Finance, TPAs, producers, carriers, and Stop Loss leadership to resolve exceptions, strengthen operational processes, and identify opportunities for continuous improvement. Things You’ll Do Here: Manage financial and administrative operations supporting the stop loss program, including premium administration, policy issuance, licensing, reconciliation, and operational controls. Ensure transactions, policy documentation, and regulatory records are accurate, timely, and audit-ready. Partner with Underwriting, Claims, Finance, TPAs, producers, carriers, and Stop Loss leadership to resolve exceptions, maintain program requirements, and improve operational processes. Administer premium receipts, lockbox and ACH activity, and application of premium to applicable groups and policies within stop loss systems. Reconcile enrollment, expected premium, and received premium and coordinates resolution of shortages, overpayments, unapplied cash, delinquent premium, and other exceptions. Coordinate return premium, commission and override payments, claim payment activity, and other assigned financial transactions with Finance and Accounts Payable while maintaining supporting reconciliation and documentation. Perform monthly premium reconciliations and supports month-end close, bordereaux, carrier reporting, and other program financial reporting. Manage the policy administration workflow following final underwriting approval, including sold-case requirements, policy and form selection, policy preparation, amendments, endorsements, and outstanding-item tracking. Review policy materials against approved underwriting terms, including deductibles, aggregate provisions, contract basis, lasers, exclusions, effective dates, terminal liability provisions, and special endorsements, and escalates discrepancies prior to issuance. Coordinate policy issuance activities performed by Stop Loss Specialists and maintains documented procedures, quality controls, and status reporting. Administer agency and producer licensing, carrier appointments, renewals, state-specific requirements, regulatory correspondence, and related documentation. Maintain TPA and producer due diligence documentation and supports applicable approval processes. Develop and maintains operational procedures, reconciliations, exception reporting, controls, and audit evidence supporting premium, policy, and licensing activities. Supports carrier, financial, and internal audits and coordinates timely resolution and documentation of identified exceptions. Develop operational reporting and identifies opportunities to improve accuracy, efficiency, transparency, controls, and cross-training. Coordinate workflows across Stop Loss Specialists and internal partners and escalates material underwriting, financial, contractual, or compliance matters to appropriate leadership. Recommend process, control, and system improvements to Stop Loss leadership and functional partners. Perform other duties as assigned. Accommodation may be made to enable individuals with disabilities to perform essential duties. What You’ll Bring to the Team: 3+ years of experience in insurance operations, premium administration, accounting or reconciliation, policy administration, or a related field. Working knowledge of self-funded medical plans, employer stop loss terminology, insurance contracts, and operational workflows. Strong reconciliation and analytical skills with the ability to work accurately across premium, enrollment, policy, and financial data. Demonstrated ability to interpret policy and underwriting terms and identify discrepancies requiring additional review. Experience managing financial or administrative processes with defined controls, deadlines, and documentation requirements. Strong attention to detail with the ability to maintain accurate, complete, and audit-ready records. Strong organizational and time-management skills with the ability to manage multiple recurring processes and deadlines. Effective written and verbal communication skills with the ability to work collaboratively with carriers, TPAs, producers, Finance, Underwriting, Claims, and other internal partners. Proficiency with Microsoft Office applications, including Excel and Word, and the ability to learn stop loss administration, underwriting, and reporting platforms. Ability to independently manage assigned operational processes within established procedures and appropriately escalation material exceptions. A plus if you have… Bachelor’s degree in Accounting, Finance, Business, Insurance, or a related field. Experience with employer stop loss, self-funded medical plans, premium administration, or policy issuance. Experience with carrier bordereaux, month-end reconciliation, or insurance financial reporting. Experience administering insurance licensing, carrier appointments, producer records, or related regulatory requirements. Experience supporting policy preparation, endorsements, amendments, or quality review of insurance documents. Experience with TPA or producer due diligence and approval processes. Experience supporting carrier, financial, compliance, or operational audits. Experience with stop loss administration, underwriting, policy, or reporting platforms. Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment! Work Environment: You’ll need a quiet workspace that is free from distractions. Technology: Reliable internet connection—if you can use streaming services, you’re good to go! Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software. Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA. Why You’ll Love Working Here Our mission is to advance healthcare through technology and expertise to optimize cost, quality, access, and utilization for all. We bring that mission to life through our commitment to Collaboration, Performance, Transparency, and Trust—the core values that guide how we work with our members, our customers, and each other. Benefits Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card. Spending account options: HSA, FSA, and DCFSA 401K with company match and immediate vesting Flexible working environment Generous Paid Time Off to include vacation, sick leave, and paid holidays Employee Assistance Program that includes professional counseling, referrals, and additional services Paid maternity and paternity leave Pet insurance Employee discounts on phone plans, car rentals and computers Community giveback opportunities, including paid time off for philanthropic endeavors At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics. #J-18808-Ljbffr Valenz