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Medical Stop Loss Jobs (NOW HIRING)

POSITION SUMMARY The Stop Loss Claim Specialist II (Specific) is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers for individual stop loss ...

POSITION SUMMARY The Stop Loss Claim Specialist is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers for individual stop loss (specific) coverage.

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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 15, 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.
More about Medical Stop Loss jobs
What cities are hiring for Medical Stop Loss jobs? Cities with the most Medical Stop Loss job openings:
What states have the most Medical Stop Loss jobs? States with the most job openings for Medical Stop Loss jobs include:
Claims Examiner, Medical Stop Loss

Claims Examiner, Medical Stop Loss

Crum & Forster

Phoenix, AZ

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago


Job description

Crum & Forster Company Overview

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.

C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.  For more information about Crum & Forster, please visit our website: www.cfins.com.

Job Description

Since 2000, Crum & Forster's Accident & Health division (A&H) has offered a diverse portfolio of specialty insurance and reinsurance products nationwide. We place a strong focus on product development and creative distribution methods, along with excellent client service and support.

In addition to our robust domestic portfolio, which spans both special risk and medical solutions, A&H works on an international basis through various partnerships. Our global capabilities provide our partners with even broader flexibility in underwriting solutions.

The qualities and capabilities of A&H demonstrate our philosophy of building meaningful, long-term partnerships and our dedication to providing alternative strategies in an ever-changing insurance market.

The A&H MBU takes a full-spectrum approach to designing and servicing a robust slate of products tailored to needs in Employer Stop Loss, Excess Medical, Life, and Ancillary and Supplemental benefits. Our diversified business model includes program partnerships as well as direct sales in Employer Stop Loss. At year-end 2025, the MBU recorded $1.02 Billion in gross premium written.

This is a unique opportunity to work with a high-quality team of leaders and benefit from the security and stability of a large organization while maintaining a nimble and responsive approach to business.  The successful candidate will work as part of a team and be responsible for evaluating claim eligibility, outlining claim exposure, processing payments to policyholders, and maintaining appropriate reporting to management.  This individual will interact internally with fellow team members and externally with the division's business partners. The C&F SL team has an objective to write and administer $2 billion in business in the next 5 years. 

What you will do for C&F:

  • Within documented authority levels, review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and Policies
  • Clearly and professionally communicate external requests for information and maintain timely follow-up
  • Clearly and professionally communicate claim payment and denial decisions
  • Confirm appropriate disclosure when applicable
  • Calculate and maintain reserves as needed
  • Assist with aggregate accommodation activities and aggregate claim submissions
  • Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility
  • Assist with refining internal claim procedures and recommending improvements to management
  • Other duties as assigned

What you will bring to C&F

  • 3+ years medical stop loss claim experience required
  • Bachelor's degree or equivalent experience required
  • Strong working knowledge of both Microsoft Office suite with an aptitude to learn new programs (ESL Office experience preferred)
  • Ability to establish a good rapport with all stakeholders
  • Commitment to delivering outstanding customer service and satisfaction
  • Commitment to exploring and assisting in implementing new processes to increase effectiveness and achieve organizational goals
  • Exceptional attention to detail and accuracy
  • Capability to manage multiple priorities in a fast-paced environment
  • Excellent written and verbal communication skills
What C&F will bring to you
  • Competitive compensation package
  • Generous 401K employer match
  • Employee Stock Purchase plan with employer matching
  • Generous Paid Time Off
  • Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing
  • A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
  • A dynamic, ambitious, fun and exciting work environment
  • We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community

At C&F you will BELONG

If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know

 For California Residents Only:  Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit https://www.cfins.com/onlineprivacypolicy/ca/noticeatcollection/  for more information.

Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws.  Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $48,300.00 to a maximum of $90,800.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.

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Employment Type: FULL_TIME