Stop Loss Claims Manager

Stop-Loss Claims Manager

Specialty Program Group (SPG) is the wholesale and 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.

A Stop-Loss Claims Manager oversees the administration, data collection, submission, and resolution of stop-loss insurance claims, ensuring accuracy, compliance, and timely processing for both Individual Stop Loss (ISL) and Aggregate Stop Loss (ASL). This role serves as a critical liaison between employers, third-party administrators (TPAs), brokers, and carriers, managing high-cost claims that exceed predetermined thresholds.

Key Responsibilities:

• Claims Oversight: Review, evaluate, and process complex stop-loss claims, ensuring they meet policy terms and conditions.
• Risk Assessment: Analyze large-dollar claims for potential coverage issues, exclusions, and reimbursement eligibility.
• Stakeholder Collaboration: Communicate with TPAs, brokers, and internal departments to gather necessary documentation and clarify claim details.
• Compliance & Accuracy: Ensure claims are handled in accordance with regulatory guidelines, contractual obligations, and internal standards.
• Reporting & Analysis: Generate detailed reports on claim activity and recovery outcomes to support underwriting and finance teams. Utilization of a multitude of data analytics platforms.
• Process Improvement: Identify opportunities to streamline workflows, enhance claim accuracy, and improve turnaround times.
• Leadership & Mentorship: Provide collaboration and guidance to fellow team members, support training initiatives, and contribute to departmental strategy.

Optimal Skills & Qualifications:

• Understanding of stop-loss insurance, medical claims, and healthcare regulations.
• Strong analytical and decision-making skills (thinking outside the box)
• Excellent communication skills.
• Proficiency in Outlook, SalesForce, Excel and Data Analytics tools.
• Ability to manage sensitive personal health information with discretion and professionalism.

Salary Transparency: Disclosure required under applicable state or municipality regulations: The expected salary range for this position is $52,000 to $55,000 and will be impacted by factors such as the successful candidate's skills, experience and working location, as well as the specific position's business line, scope and level. HUB International is proud to offer comprehensive benefit and total compensation packages which could include health/dental/vision/life/disability insurance, FSA, HSA and 401(k) accounts, paid-time-off benefits, and eligible bonuses, equity and commissions for some positions.

Department: Claims Management

Required Experience: 2-5 years of relevant experience

Required Travel: No Travel Required

Required Education: High school or equivalent

HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations.