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Medical Stop Loss Jobs (NOW HIRING)

Jencap

Senior Underwriter - Medical Stop Loss

Avon, CT · On-site

$96K - $114K/yr

The Senior Underwriter - Medical Stop Loss is responsible for the evaluation, risk assessment, pricing, and underwriting of stop loss insurance for self-funded employer groups. The ideal candidate ...

Jencap

Senior Underwriter - Medical Stop Loss

Danvers, MA · On-site +1

$104K - $123K/yr

The Senior Underwriter - Medical Stop Loss is responsible for the evaluation, risk assessment, pricing, and underwriting of stop loss insurance for self‑funded employer groups. The ideal candidate ...

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Medical Stop Loss information

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$21K

$92.6K

$178K

How much do medical stop loss jobs pay per year?

As of Jun 12, 2026, the average yearly pay for medical stop loss in the United States is $92,555.00, according to ZipRecruiter salary data. Most workers in this role earn between $84,500.00 and $84,500.00 per year, depending on experience, location, and employer.

What is medical stop loss insurance?

Medical stop loss insurance is a type of coverage purchased by employers who self-fund their employee health benefit plans. It protects them from catastrophic or unpredictable high-cost claims by reimbursing the employer when claims exceed a certain dollar amount, known as the stop-loss limit. There are two main types: individual (specific) stop loss, which covers high claims for a single person, and aggregate stop loss, which covers total claims for the group. This insurance helps employers manage financial risk while still offering health benefits to employees.

What is the difference between Medical Stop Loss vs Medical Underwriter?

AspectMedical Stop LossMedical Underwriter
Required credentialsInsurance licenses, industry certificationsInsurance licenses, actuarial certifications
Work environmentInsurance companies, brokers, third-party administratorsInsurance companies, underwriting firms
Employer and industry usageHealth insurance, self-funded plansHealth insurance, risk assessment

Medical Stop Loss professionals focus on protecting self-funded health plans from high claims, while Medical Underwriters assess risk and determine policy terms. Both roles require insurance knowledge and industry certifications, but they serve different functions within the health insurance industry.

What are some common challenges faced by professionals working in Medical Stop Loss, and how can they be managed?

Professionals in Medical Stop Loss often encounter challenges such as keeping up with evolving healthcare regulations, accurately assessing risk from complex claims data, and coordinating with brokers, underwriters, and healthcare providers. Managing these challenges requires staying informed through regular training, leveraging advanced analytics tools, and fostering strong communication with all stakeholders. Additionally, effective collaboration within a multidisciplinary team helps ensure thorough risk evaluation and timely decision-making.

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

To thrive as a Medical Stop Loss Underwriter, you need strong analytical skills, deep knowledge of health insurance, and a background in underwriting or actuarial science, often supported by a bachelor’s degree in a related field. Proficiency with risk assessment tools, underwriting software, and data management systems is typically required. Excellent attention to detail, problem-solving abilities, and effective communication with brokers and clients help professionals stand out. These skills ensure accurate risk evaluation and policy pricing, which are critical for maintaining profitability and client satisfaction in the medical stop loss industry.
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Medical Stop Loss jobs near you

Medical Stop Loss Claims Auditor

EVOLUTION RISK PARTNERS, LLC

Evanston, IL • On-site

$75K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 23 days ago

Job description

Stop Loss Claims Auditor or Senior Stop Loss Claims Auditor

The Stop Loss Auditor is responsible for auditing and authorizing reimbursements of specific claims and effectively mitigate client medical stop loss claims and provide excellent customer service.

Experience/Qualifications:

  • 3-5+ years of experience in auditing medical Stop Loss Claims.
  • Audit stop loss claims and verify claims are paid in accordance with the Plan Document and reimbursable under the stop loss contract.
  • Timely follow-up of pending claims to ensure additional information is received.
  • Recognize cost mitigation opportunities.
  • Interpret plan languages and stop loss contracts.
  • Familiar with the process of referring claims for over-authority review and approval to the carrier.
  • Efficient communication with both internal and external customers
  • Experience with auditing aggregate claims
  • Captive experience a plus
  • Ability to analyze claims and/or large claim management reports to post and/or adjust reserves.

Skills/Abilities

  • 2-3 years medical claim processing or 3-5+ years Stop Loss Claims Auditing and reinsurance experience.
  • Bachelor’s degree a plus.
  • Experience TPA Claims Processing and cost mitigation.
  • Proficient in Excel (for example: sorting, filtering, data, creating pivot tables.)
  • Ability to interpret and understand Plan Document wording and the application of provisions including eligibility.
  • Knowledge in COB, Medicare rules, CPT codes, REV codes, ICD-10 codes, HCPCS codes, J-codes
  • Excellent customer service, organizational with strong analytical skills
  • Detail/results-oriented
  • Ability to work independently with minimal supervision while meeting or exceeding established production and accuracy standards.
  • Ability to interpret and understand Stop Loss Contracts
  • Customer Service focused.
  • Excellent verbal and written communication skills

What We Offer:

We're proud to offer a competitive salary, generous and flexible PTO & paid holidays, 401(k) with match, exclusive discount programs, health & wellness programs, and more.

Benefits:

  • Health insurance
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible spending account
  • Health savings account
  • Life insurance
  • Vision insurance

About Evolution Risk Partners, LLC

Evolution Risk Partners (ERP) is a full service Managing General Underwriter redefines partnership through a shared vision of success with employers and brokers. We provide organizations with customizable and innovative medical stop-loss solutions to ensure the financial stability of your self-funded medical program. Interested parties should visit www.evolutionrisk.com.