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Stop Loss Claims Auditor Jobs (NOW HIRING)

Ourhrconnect

$72K - $94K/yr

Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors. To Qualify for This Position, You'll Need the Following:

Risk Strategies

Specific Stop Loss Claims Auditor

$51K - $75K/yr

The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

Risk Strategies

Specific Stop Loss Claims Auditor

$51K - $75K/yr

The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

Brown & Brown, Inc.

Trainer Stop Loss Claims

$80K - $100K/yr

The incumbent is responsible for providing training for newly hired Specific Stop Loss claims auditors and refresher training for all Specific Stop Loss claims auditors. How You Will Contribute:

Brown & Brown Insurance

Trainer Stop Loss Claims

$80K - $100K/yr

The incumbentis responsible forproviding training for newly hired Specific Stop Loss claims auditors and refresher training for all Specific Stop Loss claims auditors. How You Will Contribute:

Risk Strategies

Health Claims Stop Loss Auditor

$51K - $75K/yr

The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

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How much do stop loss claims auditor jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for stop loss claims auditor in the United States is $26.83, according to ZipRecruiter salary data. Most workers in this role earn between $19.71 and $29.81 per hour, depending on experience, location, and employer.

What is a stop loss claims auditor?

Stop Loss Claims Auditors are professionals who review and evaluate insurance claims submitted under stop loss insurance policies. Their main role is to ensure that claims meet policy requirements and are processed accurately before reimbursement is made by the stop loss insurer. They analyze documentation, verify eligibility, and check for errors or inconsistencies in claims data. Auditors may also work with employers, third-party administrators, and insurers to resolve discrepancies and prevent fraud. Their work helps maintain the financial integrity of stop loss insurance programs.

What are the key skills and qualifications needed to thrive as a stop loss claims auditor?

To thrive as a Stop Loss Claims Auditor, you need a deep understanding of health insurance claims processing, stop loss policies, and regulatory compliance, typically supported by experience in medical claims or insurance auditing. Familiarity with claims management software, auditing tools, and knowledge of HIPAA regulations are essential, and certifications like Certified Professional Medical Auditor (CPMA) can be advantageous. Strong attention to detail, analytical thinking, and effective communication skills set top performers apart in this role. These skills are crucial for ensuring accurate claim assessments, minimizing financial risk, and maintaining compliance for insurance providers.

What are some common challenges faced by stop loss claims auditors, and how can they be addressed?

Stop Loss Claims Auditors often encounter challenges such as interpreting complex policy language, identifying potential discrepancies in large volumes of claims data, and ensuring compliance with both regulatory and client-specific guidelines. Staying current with the latest industry regulations and using advanced claims management software can help mitigate these challenges. Collaborating closely with underwriters, claims analysts, and medical review teams also supports accurate and timely claims adjudication. Continuous professional development and attention to detail are key to success in this role.
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Stop Loss Claims Auditor jobs near you
Infographic showing various Stop Loss Claims Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.

Medical Stop Loss Claims Auditor

EVOLUTION RISK PARTNERS, LLC

Evanston, IL • On-site

$75K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 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.