Director Stop Loss Rn Jobs in Bridgewater, MA (NOW HIRING)

Who We Are
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
Job Summary
The Reinsurance Specialist will report to the Director of Underwriting. The Reinsurance Specialist ensures accurate, timely stop-loss premium, claims, reimbursement, and payment data for the health plan's Self-funded accounts including reinsurance and LMF product by validating monthly sources and resolving variances with cross-functional teams and the vendor. They manage reinsurance inquiries via a centralized mailbox and maintain clear documentation and standard operating procedures (SOPs) for decisions and issue resolution. They also support compliance and close activities by coordinating stop-loss policy filings, settlement/ surplus reporting with the Settlement Coordinator, month/period-end tie-outs, and audit/reporting requirements aligned to reinsurance agreements.
The individual will need to be self-motivated with the ability to work independently and within a team environment with strong follow-up, organization/prioritization skills, and excellent attention to detail. The individual is required to maintain confidential information/correspondence and be responsible for meeting extremely tight deadlines.
Reinsurance Specialist should independently manage essential functions, teach those skills to staff, prioritize them and seek assistance from company UW management team members. These functions need to be performed on a consistent and regular basis, using strong judgment. Requires the ability to learn and apply all company Plan policies consistently. The Reinsurance Specialist is expected to seek guidance from Underwriting management when appropriate. Additional responsibilities include developing and maintaining reports using various systems.
Job Description
Key Responsibilities/Duties - what you will be doing:

• Stop-Loss Management

• Review reinsurance payment details for accuracy, completeness, and timeliness.
• Review and validate premium, claims, and reimbursement data to confirm alignment and quality across sources (monthly)
• Identify variances, investigate root causes, and coordinate resolution with the appropriate teams.
• Ensures stop-loss policy filings are prepared, submitted, tracked, and kept compliant/approved with required regulators and internal governance

• Settlement Payments

• Partner with the Settlement Coordinator to support settlement/ surplus reporting and related analyses.
• Support month-end and period-end close activities, including required tie-outs and documentation.

• Communications & Inquiry Management

• Establish and manage reinsurance mailbox, respond to inquiries and route issues (Finance, Claims, Sales, etc.)
• Maintain documentation of decisions, resolutions, and standard operating procedures (SOPs)
• Support audit requests and reporting needs and ensure adherence to reinsurance agreement requirements.

• Reconciliation accuracy & timeliness: % of monthly premium/claims/reimbursement tie-outs completed on-time and accepted with no rework.
• Stop-loss payment review quality: % of vendor payment details reviewed within SLA and error/variance rate identified (and prevented from posting).
• Variance resolution cycle time: Average days to triage, root-cause, and close variances (including % closed within target SLA).
• Compliance & audit readiness: % of required stop-loss filings submitted/approved by deadlines and audit request turnaround time (with complete support on first pass).

Qualifications - what you need to perform the job
Education, Certification and Licensure

• Bachelor's Degree (Mathematics, Statistics, Actuarial Science, Accounting, Finance, or other analytical discipline)

Experience (minimum years required):

• 5-7 years' experience in health plan finance/operations and/or claims finance
• Demonstrated experience supporting close cycles and working with external vendors
• Prior exposure to regulatory filing coordination
• Stop-loss (medical) reinsurance knowledge (policy terms, reimbursement mechanics, attachments/lasers, exclusions)
• Level monthly funded product familiarity (how premiums, claims funding, and settlements flow)
• Understanding of reinsurance agreement requirements and operational compliance obligations
• Familiarity with monthly data validation across sources, as well as financial reconciliations, tie-outs, and variance analysis
• Experience with root-cause analysis of data/process discrepancies
• Experience with SOP creation/maintenance and process documentation
• Experience with shared mailbox/work intake management and issue tracking
• Excellent verbal and written communication skills

Skill Requirements

• Well-developed verbal and written communication skills
• Ability to exercise sound judgment and raise issues to appropriate senior Underwriting leaders for resolution.

• Proficiency with MS Office applications (Excel, Access, Word, PowerPoint)

• Requires the ability to work collaboratively as part of a team.
• Must be able to effectively communicate with all internal departments in verbal and written formats.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Disclaimer
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
Salary Range
$68,440.00 -$102,660.00
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org