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Remote Stop Loss Insurance Jobs in Georgia (NOW HIRING)

CSAA

Job Title Commercial Insurance Consultant, Claims Insights- Remote Requisition Number R7770 ... Formulate datadriven recommendations to improve operational efficiency, loss outcomes, and business ...

Reserv, Inc.

Trucking Total Loss Adjuster

Atlanta, GA · On-site +1

... TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable ... Bachelor's degree (lack of one should not stop you from applying if you possess all the other ...

Great American Insurance Group

$105K - $115K/yr

Great American Insurance Group's member companies are subsidiaries of American Financial Group. We ... Our service in claims and loss control is second to none. We've found that a large majority of our ...

CSAA

... Insurance Group (CSAA IG), a AAA insurer, is one of the leading personal lines property and ... Your Work: * Manage homeowners property claims from first notice of loss through resolution ...

New

CSAA

Develops and analyzes new methodologies for insurance rating and loss reserving Required Experience ... We embrace a remote-first culture through our Flexible Workplace. Most employees hold Home-Flex ...

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All JobsStop Loss Insurance JobsRemote Stop Loss Insurance JobsRemote Stop Loss Insurance Jobs in Georgia

Remote Stop Loss Insurance information

What are the key skills and qualifications needed to thrive as a remote stop loss insurance specialist, and why are they important?

To excel as a Remote Stop Loss Insurance Specialist, you need expertise in health insurance underwriting, risk assessment, and policy analysis, often supported by a background in insurance or finance. Familiarity with industry-standard claims management systems, CRM platforms, and regulatory compliance tools is essential. Strong analytical thinking, attention to detail, and effective written communication are crucial soft skills for success in a remote environment. These abilities ensure accurate risk evaluation, regulatory adherence, and clear client interactions, which are critical for managing high-value stop loss insurance contracts.

What is remote stop loss insurance?

Remote stop loss insurance is a type of coverage designed to protect self-funded employers from large or catastrophic claims, but managed and administered through digital or remote platforms. This insurance reimburses employers for claims that exceed a predetermined limit, helping them manage risk and avoid significant financial loss. The 'remote' aspect refers to the use of online tools and services for policy management, claims processing, and communication, allowing for flexible and efficient administration without the need for in-person meetings. This is particularly beneficial for companies with distributed teams or those seeking streamlined, technology-driven solutions.

What is the difference between Remote Stop Loss Insurance vs Remote Underwriter?

AspectRemote Stop Loss InsuranceRemote Underwriter
CredentialsInsurance licenses, actuarial knowledgeInsurance licenses, underwriting certifications
Work EnvironmentInsurance companies, brokers, remoteInsurance companies, remote or office
Industry UsageHealth and self-funded plansInsurance policy assessment and risk evaluation

Remote Stop Loss Insurance professionals focus on providing coverage for self-funded health plans, managing risk, and setting policy terms. Remote Underwriters evaluate insurance applications, assess risks, and determine policy eligibility. While both roles require insurance knowledge and licenses, Stop Loss Insurance specialists concentrate on risk management for health plans, whereas Underwriters focus on evaluating individual applications. Understanding these differences helps clarify career paths and job expectations in the insurance industry.

What are some common challenges faced by professionals working in remote stop loss insurance roles?

One common challenge in remote stop loss insurance roles is maintaining clear and effective communication with underwriters, brokers, and clients, since much of the collaboration happens virtually. Additionally, staying updated on changing regulations and market trends requires proactive self-learning and digital resourcefulness. Managing sensitive data securely and ensuring timely turnaround on complex claims or policy analysis can also be demanding when working remotely. Building strong relationships with team members and clients, despite the lack of in-person interaction, is key to long-term success in this field.
What are the most commonly searched types of Stop Loss Insurance jobs in Georgia? The most popular types of Stop Loss Insurance jobs in Georgia are:
What are popular job titles related to Remote Stop Loss Insurance jobs in Georgia? For Remote Stop Loss Insurance jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Remote Stop Loss Insurance jobs in Georgia look for? The top searched job categories for Remote Stop Loss Insurance jobs in Georgia are:
What cities in Georgia are hiring for Remote Stop Loss Insurance jobs? Cities in Georgia with the most Remote Stop Loss Insurance job openings:
Remote Stop Loss Insurance jobs near you

Director of Clinical & Cost Containment, Employee Benefits

HUB International Limited

Atlanta, GA • On-site, Remote

$76K - $104K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 days ago

HUB International rating

8.0

Company rating: 8.0 out of 10

Based on 140 frontline employees who took The Breakroom Quiz

163rd of 301 rated insurance

Job description

Position Summary
The Director of Clinical & Cost Containment is a senior strategic role within Strategic Benefit Resources (SBR) responsible for leading the clinical consulting and cost containment program capabilities that differentiate SBR's self-funded solutions in the wholesale distribution market. This individual serves as the primary clinical subject matter expert across SBR's book of business, partnering with sales, distribution, and stop-loss consulting teams to evaluate, implement, and communicate clinical cost containment strategies that drive measurable financial outcomes for employer clients.
This role bridges clinical expertise and consultative sales support - working directly with broker/consultant partners, TPAs, stop-loss carriers, and employer plan sponsors to identify high-cost claim drivers, optimize vendor program selection, and develop clinical frameworks that reduce plan cost and improve member outcomes.
Why This Role Exists
As the self-funded benefits market grows increasingly complex - driven by specialty drug spend, catastrophic claim frequency, and heightened employer demand for transparency - SBR's distribution model requires dedicated clinical leadership to:
  • Evaluate and validate cost containment vendor solutions (Rx carve-outs, case management, utilization review, reference-based pricing, direct contracting) presented to clients
  • Provide clinical oversight and credibility in stop-loss consulting engagements
  • Identify coverage gap risks (e.g., Rx carved out of medical stop-loss) and proactively protect clients and SBR's risk profile
  • Position SBR as a value-added clinical advisory resource to differentiate from transactional wholesale competitors

Key Responsibilities
Clinical Cost Containment Strategy
  • Lead the development and ongoing refinement of SBR's clinical cost containment framework, aligning strategies with market trends and client needs
  • Evaluate, vet, and recommend cost containment vendors and programs (utilization management, case management, pharmacy benefit management, transplant networks, reference-based pricing, direct primary care, etc.)
  • Analyze claims data, clinical utilization trends, and high-cost claimant profiles to identify actionable savings opportunities
  • Monitor medical cost trends, specialty drug pipelines, and catastrophic claim drivers to proactively advise clients and sales teams

Stop-Loss Carrier Support / Claims Support
  • Review TPA trigger reports and claim referrals to surface impending high-cost diagnoses and recommend clinical risk mitigation actions
  • Identify and communicate coverage gap risks when Rx is carved out of stop-loss contracts or when benefit plan design creates clinical exposure
  • Serve as clinical liaison between SBR, stop-loss carriers, TPAs, and employer plan sponsors on complex claims and risk management issues

Consulting & Distribution Enablement
  • Support SBR's sales and consulting teams with clinical presentations, client-facing materials, and technical talking points for broker/consultant audiences
  • Conduct clinical reviews and plan analyses for prospective and existing employer clients, translating clinical findings into financial impact narratives
  • Develop educational resources, webinars, and market-facing content that position SBR's clinical expertise as a competitive differentiator
  • Partner with distribution leadership and brokers/consultants to align cost containment program recommendations with individual client risk profiles and plan designs

Vendor Management & Program Oversight
  • Build and maintain relationships with clinical cost containment vendors, including case management firms, utilization review organizations, PBMs, and specialty program providers
  • Evaluate vendor performance through KPI monitoring, outcome tracking, and savings validation
  • Negotiate program terms and coordinate seamless integration of clinical vendors within the SBR distribution ecosystem
  • Stay current on regulatory developments, ERISA compliance requirements, and clinical best practices affecting self-funded plan design

Internal Leadership & Collaboration
  • Partner with the Chief Strategy Officer, COO, and sales leadership to align clinical strategy with SBR's overall growth objectives
  • Provide clinical training and education to internal SBR teams, ensuring consultants can confidently represent cost containment solutions
  • Contribute to the development of SBR's strategic plan as it relates to clinical program expansion, new vendor partnerships, and market positioning

Qualifications
Required
  • Bachelor's degree in Nursing, Healthcare Administration, Health Sciences, or a related clinical field; RN license strongly preferred
  • 5+ years of experience in clinical cost containment, case management, utilization management, stop-loss, or self-funded health plan consulting
  • Deep knowledge of self-funded employer benefit plan design, stop-loss insurance structures, and the TPA/wholesale distribution market
  • Demonstrated understanding of medical coding (ICD-10, CPT), clinical guidelines, and claims adjudication processes
  • Experience working with or evaluating cost containment vendors including case management, PBMs, reference-based pricing, and specialty drug management programs
  • Strong analytical and data interpretation skills; ability to translate clinical findings into financial and strategic insights
  • Excellent communication, presentation, and relationship management skills with broker, consultant, and employer-level audiences

Preferred
  • Certification in Case Management (CCM), Certified Employee Benefit Specialist (CEBS), or equivalent professional credential
  • Experience with pharmacy carve-out structures and Rx cost containment programs in the self-funded context (e.g., PMPM guarantee models, closed formulary programs)
  • Familiarity with all types of self funded arrangements including captive insurance structures, level-funded plans, or consortium-based stop-loss arrangements
  • Prior experience in a wholesale benefits distribution, MGU, or TPA environment
  • Working knowledge of ERISA, HIPAA, ACA implications for self-funded plan sponsors

Core Competencies
  • Clinical Expertise & Credibility - Trusted subject matter authority on medical management and cost containment within the self-funded market
  • Strategic Thinking - Connects clinical insights to business outcomes and competitive positioning
  • Consultative Communication - Translates complex clinical concepts for non-clinical stakeholders including brokers, employers, and executives
  • Analytical Rigor - Data-driven approach to evaluating program performance and identifying savings opportunities
  • Relationship Building - Skilled at developing trusted partnerships with vendors, TPAs, carriers, and distribution partners
  • Market Awareness - Proactive in monitoring industry trends, emerging cost drivers, and regulatory changes

Compensation & Benefits
SBR offers a competitive compensation package commensurate with experience, including:
  • Base salary commensurate with experience
  • Performance-based incentive compensation
  • Comprehensive health, dental, and vision benefits
  • Retirement plan with employer contribution
  • Professional development and continuing education support
  • Hybrid/remote work flexibility

The expected salary range for this position is $130,000 to $150,000 and will be impacted by factors such as the successful candidate's skills, experience and working location, as well as the specific position's business line, scope and level. HUB International is proud to offer comprehensive benefit and total compensation packages which could include health/dental/vision/life/disability insurance, FSA, HAS and 401(k) accounts, paid-time-off benefits such as vacation, sick, personal, floating holidays and company holidays. In addition, eligible annual bonuses, equity and commissions may be available for some positions.
#SPG
Department Business Operations
Required Experience: 5-7 years of relevant experience
Required Travel: Up to 25%
Required Education: Bachelor's degree (4-year degree)
HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations.
E-Verify Program
We endeavor to make this website accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the recruiting team HUBRecruiting@hubinternational.com. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications.

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