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Director Stop Loss Rn Jobs in Kentucky (NOW HIRING)

$68 - $102/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The opportunity Senior Manager, Stop Loss and Health Claims leads our dynamic claims unit. In this ... Direct the evaluation, investigation, negotiation, and settlement of complex claims, ensuring ...

New

Registered Nurse

Lexington, KY · On-site

$36 - $40/hr

  • Medical

  • PTO

Provide comprehensive nursing assessments and direct patient care * Assist physicians and advanced ... One Stop Recruiting is an equal opportunity employer. We offer equal employment and contract ...

Registered Nurse

Lexington, KY · On-site

$36 - $40/hr

  • Medical

  • PTO

Provide comprehensive nursing assessments and direct patient care * Assist physicians and advanced ... One Stop Recruiting is an equal opportunity employer. We offer equal employment and contract ...

$61 - $130/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Candidate must have active and unrestricted Compact Registered Nurse (RN) Licensure in OH or in ... You must have or be able to obtain a direct/hardwired internet connection to a modem/router within ...

New

$61 - $130/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Remote RN Case Manager (100% Telework) Work from anywhere in the U.S. Join a team dedicated to ... You must have or be able to obtain a direct/hardwired internet connection to a modem/router within ...

New

Registered Nurse (RN)

Danville, KY · On-site

$40.20/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide direct nursing care to residents, including medication administration, wound care, and ... First Stop Health Virtual Healthcare * 401(k) & Roth 401(k) * Company-Paid & Voluntary Life ...

Registered Nurse

Lexington, KY · On-site

$40 - $45/hr

  • Medical

  • PTO

Provide comprehensive nursing assessments and direct patient care Assist physicians and advanced ... JOB-11757 Valerie Kramer #ESJ1 One Stop Recruiting is an equal opportunity employer. We offer equal ...

Registered Nurse (RN)

Owensboro, KY · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are committed to advancing person-directed care and quality outcomes. Many of our facilities ... First Stop Health Virtual Healthcare * 401(k) & Roth 401(k) * Company-Paid & Voluntary Life ...

Registered Nurse (RN)

Owensboro, KY · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are committed to advancing person-directed care and quality outcomes. Many of our facilities ... First Stop Health Virtual Healthcare * 401(k) & Roth 401(k) * Company-Paid & Voluntary Life ...

Registered Nurse (RN)

Morgantown, KY · On-site

$52.51/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are committed to advancing person-directed care and quality outcomes. Many of our facilities ... First Stop Health Virtual Healthcare * 401(k) & Roth 401(k) * Company-Paid & Voluntary Life ...

Registered Nurse (RN)

Owensboro, KY · On-site

$38 - $43.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are committed to advancing person-directed care and quality outcomes. Many of our facilities ... First Stop Health Virtual Healthcare * 401(k) & Roth 401(k) * Company-Paid & Voluntary Life ...

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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 are the most commonly searched types of Stop Loss Rn jobs in Kentucky?

The most popular types of Stop Loss Rn jobs in Kentucky are:

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

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

Senior Manager, Stop Loss & Health Claims

The Mississippi Bar

On-site

$68 - $102/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

New


Job description

Job Description

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful.

When you join Sun Life, you'll work with passionate colleagues and empowering leaders who support your growth and celebrate your contributions, so you can make a meaningful difference in our Clients' lives.

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

The opportunity

Senior Manager, Stop Loss and Health Claims leads our dynamic claims unit. In this critical role, you'll oversee complex claims operations, manage a high-performing team, and collaborate with key partners to drive our continued growth and excellence in customer service.

How you will contribute
  • Lead Claims Operations: Direct the evaluation, investigation, negotiation, and settlement of complex claims, ensuring optimal balance between policyholder interests and company objectives.
  • Manage and Develop Staff: Supervise, mentor, and grow a talented claims team, overseeing work assignments, performance management, and professional development.
  • Optimize Processes: Monitor workflow, implement efficiencies, and ensure prompt, accurate claims processing to enhance operational effectiveness.
  • Collaborate with Partners: Work closely with third-party administrators, brokers, agents, policyholders, vendors, and legal counsel to maintain Sun Life's strong reputation and drive business growth.
What you will bring with you
  • Ability to work with a diverse range of people
  • 5+ years of medical stop loss insurance or health insurance claims experience required, previous management/leadership experience preferred
  • Proven leadership skills and deep industry expertise
  • Strong analytical and problem-solving abilities
  • Experience in stakeholder management and customer-facing roles
  • In-depth knowledge of claims practices, state and federal laws
  • Excellent communication and negotiation skills
  • Ability to analyze and communicate complex data and trends
  • Proficiency with claims management systems and Sun Life products
Salary

$68,200-$102,300

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.comto request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Category

Claims - Health & Dental

Posting End Date

30/08/2026

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