Job Description

Position Summary: We are looking for a knowledgeable Stop Loss Analyst to join our team, focusing on group health insurance and underwriting. The ideal candidate will have extensive expertise in stop loss insurance, a strong analytical mindset, and relevant industry experience. This role will involve thorough analysis of claims data, financial performance, and risk management strategies. Strong communication skills and proficiency in Excel are essential, as is a solid understanding of stop loss insurance structures, pricing, and compliance regulations.

Key Responsibilities:

• Conduct risk assessments for self-funded and level-funded health insurance programs, offering well-informed recommendations.
• Analyze various stop-loss coverage options (individual and aggregate) to help employers manage health plan risks effectively.
• Review and interpret healthcare claims data, financial reports, and stop-loss insurance performance, identifying trends and generating actionable insights.
• Generate and analyze claims reports, loss ratio reports, and other data to inform underwriting decisions and risk management strategies.
• Collaborate with underwriting and actuarial teams to create precise stop-loss pricing models and comprehensive risk assessments.
• Interpret stop loss insurance policies and contracts, ensuring a clear understanding of terms, conditions, and coverage limits.
• Stay abreast of industry regulations, compliance requirements, and emerging risks associated with stop-loss insurance and health plans.
• Document and present findings, analysis, and recommendations to internal and external stakeholders in a clear and concise manner.
• Assist in the renewal process for stop-loss contracts through updated claims and risk evaluations.
• Resolve issues related to claims, policy interpretation, or coverage disputes efficiently.
• Maintain accuracy in managing policy details, claims processing, and financial calculations to ensure proper coverage.

Qualifications:

• Bachelor's degree in Finance, Actuarial Science, Business, Healthcare Administration, or a related field, or equivalent experience.
• 3-5 years of experience in group insurance, underwriting, or stop-loss analysis.
• In-depth knowledge of self-funded and level-funded health insurance programs, specifically stop-loss insurance.
• Strong proficiency in analyzing claims data and financial reports related to stop-loss performance.
• Advanced Excel skills, including data analysis tools and software (e.g., SQL).
• Excellent analytical skills focused on trend identification, risk assessment, and stop-loss option evaluation.
• Strong written and verbal communication skills, capable of presenting complex analyses clearly and concisely.
• Comprehensive understanding of insurance products, industry regulations, and compliance related to stop-loss insurance and health plans.
• Strong problem-solving abilities to address claims issues, policy interpretations, and disputes.

Preferred Qualifications:

• Experience with self-funded employers or stop-loss insurance carriers.
• Familiarity with regulatory compliance for self-funded and level-funded insurance programs.
• Progress towards actuarial certification or relevant actuarial experience is a plus.

Join Us: This is a fantastic opportunity for a skilled analyst to contribute to a dynamic team, playing a critical role in managing and mitigating risks associated with group health insurance plans. If you are passionate about healthcare claims analysis, stop-loss underwriting, and risk management, we encourage you to apply.

Location: 100 Decker Ct., Suite 250, Irving, TX 75062

Job Type: Full-time

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