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Director Stop Loss Rn Jobs in Florida (NOW HIRING)

The Director of Claims reports directly to the Vice President of Claims and is responsible for ... Stop Loss experience strongly preferred. * Industry Knowledge: Strong understanding of Stop Loss ...

The Director of Claims reports directly to the Vice President of Claims and is responsible for ... Stop Loss experience strongly preferred. * Industry Knowledge: Strong understanding of Stop Loss ...

RN Case Manager

Fort Myers, FL · On-site

$73 - $109/hr

RN Case Manager JOB DETAILS POSITION SUMMARY - RN Case Manager MINIMUM REQUIRED QUALIFICATIONS - 2 ... stop there. There are many additional benefits to enjoy, including: * Medical, dental and vision ...

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Director Stop Loss Rn information

What does a Director Stop Loss RN do?

A Director Stop Loss RN is a registered nurse who oversees and manages stop loss insurance programs within healthcare organizations. Their primary responsibility is to evaluate high-cost claims, coordinate care management, and ensure that stop loss coverage is effectively utilized to protect the organization from excessive financial losses. They also collaborate with clinical teams, insurers, and third-party administrators to optimize patient outcomes and cost containment strategies. Additionally, they may be involved in policy development, compliance, and reporting related to stop loss insurance.

What are some common challenges faced by a Director Stop Loss RN, and how can they be addressed?

A Director Stop Loss RN often encounters challenges such as balancing complex case reviews with administrative responsibilities, ensuring compliance with changing regulations, and effectively communicating with both clinical and non-clinical teams. Addressing these challenges requires strong organizational skills, continuous education on industry updates, and fostering open communication channels with underwriters, claims analysts, and healthcare providers. Prioritizing tasks and leveraging technology for data management can also help streamline workflows and enhance team collaboration.

What are the key skills and qualifications needed to thrive as a Director Stop Loss RN, and why are they important?

To thrive as a Director Stop Loss RN, you need extensive clinical nursing experience, a current RN license, and strong knowledge of stop loss insurance and healthcare risk management. Familiarity with claims adjudication systems, utilization review software, and relevant certifications such as CCM (Certified Case Manager) are highly beneficial. Leadership, analytical thinking, and effective communication are crucial soft skills for overseeing teams and collaborating with stakeholders. These skills ensure accurate risk assessment, efficient claims processing, and optimal financial and clinical outcomes for organizations.

What is the difference between Director Stop Loss Rn vs Stop Loss Nurse?

AspectDirector Stop Loss RnStop Loss Nurse
CredentialsRN license, industry certificationsRN license, specialized training
Work EnvironmentManagement, policy development, oversightPatient care, clinical support
Employer & IndustryInsurance companies, healthcare organizationsHospitals, clinics, insurance providers
Search & Comparison IntentLeadership roles in stop loss insuranceClinical roles related to stop loss coverage

The main difference is that the Director Stop Loss Rn focuses on managing stop loss insurance programs from a leadership and policy perspective, often overseeing teams and strategy. In contrast, the Stop Loss Nurse is primarily involved in clinical patient care and support within the stop loss insurance context. Both roles require RN credentials but serve different functions within the healthcare and insurance industries.

What cities in Florida are hiring for Director Stop Loss Rn jobs?

Cities in Florida with the most Director Stop Loss Rn job openings:

Self-Funded Director, Claims

Amwins

Tampa, FL

Full-time

Posted 18 days ago


Amwins rating

7.8

Company rating: 7.8 out of 10

Based on 38 frontline employees who took The Breakroom Quiz

194th of 310 rated insurance


Job description

Join Our Team as a Director of Claims at Amwins Self-Funded!

The Director of Claims reports directly to the Vice President of Claims and is responsible for providing operational and strategic leadership to the Amwins Self-Funded Claims Department. This role drives service excellence, staff development, and continuous improvement across assigned Claims divisions. This is an in-office position with the option to work from home up to two days per week after an initial training period.

Why Choose Amwins?

At Amwins, we value our team members and offer a range of benefits to enhance your work experience:

  • Flexibility: Lead in a hybrid environment that supports strategic focus, collaboration, and the flexibility needed to support balance.
  • Comprehensive Rewards: Receive a competitive benefits package from day one, including generous Paid Time Off (PTO), paid holidays, and programs designed to support your well-being and long-term success.
  • Continuous Leadership Growth: Advance your expertise in a collaborative, education-focused environment that values innovation, knowledge sharing, and leadership development.
  • Performance-Based Incentives: Participate in an annual bonus program that recognizes leadership impact, achievement of key business objectives, and contributions to the company's continued success.

Learn more about us at amwins.com/benefits.

Responsibilities:

  • Client & Partner Engagement: Drive exceptional client service and service-level agreement performance while strengthening relationships with internal teams, senior leadership, carriers, brokers, consultants, and administrators. Represent Claims in key forums with clear, actionable updates on performance, initiatives, and industry trends, as requested.
  • Strategic & Operational Leadership: Partner with senior leadership to set priorities, performance targets, and strategies that advance growth, profitability, service quality, and scalable claims operations. Execute process, policy, and technology improvements that strengthen consistency across the department.
  • People Leadership & Development: Lead, coach, and develop Claims Managers, Claims Leads, and Analysts to build capability, strengthen performance, and support career growth. Oversee training, performance management, talent decisions, and QA alignment to ensure effective execution.
  • Operational Oversight & Performance Management: Oversee assigned Claims teams to ensure productivity, quality, inventory, staffing, and service performance meet expectations. Use metrics, reporting, and workload insights to improve efficiency, accuracy, compliance, and client satisfaction.
  • Subject Matter Expertise (SME) & Department Representation: Serve as a trusted SME on complex claims, emerging regulations, escalations, and department processes. Provide technical guidance and represent Claims in meetings, trainings, and cross-functional initiatives that improve workflows and strengthen best practices.
  • Quality, Compliance & Continuous Improvement: Lead quality, compliance, and continuous improvement efforts that protect service standards, PHI, and regulatory requirements. Translate performance trends into corrective actions that strengthen consistency, mitigate risk, and improve departmental outcomes.
  • Other Duties: Support additional duties and projects as business needs evolve.

Qualifications include:

  • Leadership Experience: 7+ years of progressive responsibility in a leadership role, managing direct and indirect reports, with demonstrated experience coaching and developing managers or large teams required.
  • Industry Experience: 10+ years of experience in Group Benefits Claims; Stop Loss experience strongly preferred.
  • Industry Knowledge: Strong understanding of Stop Loss policy terms, claims handling best practices and applicable regulations (e.g., HIPPA, PHI, COBRA, ACA). Proven experience managing complex claims portfolios, including high-dollar reimbursement requests and escalated case reviews, preferred.
  • Operational & Process Mindset: Experience improving or maintaining departmental workflows, production standards, and quality measures.
  • Communication & Relationship Building: Strong ability to communicate clearly, collaborate across teams, and build trust with internal and external partners.
  • Education: Bachelor's degree strongly preferred.
  • Tech Proficiency: Strong technical aptitude with experience working within all Microsoft Office programs (Excel, Outlook, SharePoint, Teams etc.) and data reporting tools.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


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