ZipRecruiter

Log In

1

Stop Loss Claims Manager Jobs (NOW HIRING)

Amwins

Amwins A&H- Claims Manager, Stop Loss

Seattle, WA · On-site

Manager, Stop Loss Claims (Remote) Amwins Accident & Health Underwriters, formerly known as Beacon Risk Strategies, is conducting a search looking for an experienced Manager, Stop loss Claims. Amwins ...

Symetra

Manager - Stop Loss Claims - Remote

$96K - $161K/yr

Symetra has an exciting opportunity to join our team as a Manager, Stop Loss Claims! About the role In this role, you will lead daily claims operations while driving service excellence, operational ...

Ourhrconnect

Senior Stop Loss Claims Auditor

Columbia, SC · Remote

$72K - $94K/yr

Communicate effectively with carriers, vendors, and management. Provide full claims service to both ... Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors ...

next page

Showing results 1-20

All JobsStop Loss Claims JobsStop Loss Claims Manager Jobs

Stop Loss Claims Manager information

See salary details

$35K

$87.9K

$139K

How much do stop loss claims manager jobs pay per year?

As of Jul 26, 2026, the average yearly pay for stop loss claims manager in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

What is a Stop Loss Claims Manager?

A Stop Loss Claims Manager is a professional responsible for overseeing and processing stop loss insurance claims for self-funded employer health plans. Their main duties include reviewing large or catastrophic medical claims, ensuring compliance with policy terms, and coordinating with third-party administrators and carriers. They help protect employers from excessive healthcare costs by ensuring claims are handled efficiently and accurately. Their expertise helps mitigate financial risk and ensures timely reimbursement for eligible claims.

What are some common challenges faced by Stop Loss Claims Managers and how can they be effectively addressed?

Stop Loss Claims Managers often encounter challenges such as interpreting complex policy language, managing high volumes of claims, and ensuring timely, accurate adjudication. Effective communication with brokers, underwriters, and clients is crucial to resolve discrepancies and clarify coverage terms. Staying updated on regulatory changes and leveraging technology for claims processing can help streamline workflows and reduce errors. Developing strong analytical skills and fostering collaborative relationships within the claims and underwriting teams are also key to overcoming these challenges.

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

To thrive as a Stop Loss Claims Manager, you need expertise in stop loss insurance products, claims adjudication, and a solid understanding of health insurance regulations, typically supported by a bachelor's degree in a related field. Familiarity with claims management systems, data analysis tools, and industry-specific software such as Facets or QicLink is commonly required. Strong analytical thinking, attention to detail, and effective communication skills help you stand out in this role. These skills ensure accurate claims processing, regulatory compliance, and effective collaboration with clients and underwriters.
More about Stop Loss Claims Manager jobs
What cities are hiring for Stop Loss Claims Manager jobs? Cities with the most Stop Loss Claims Manager job openings:
What states have the most Stop Loss Claims Manager jobs? States with the most job openings for Stop Loss Claims Manager jobs include:
What job categories do people searching Stop Loss Claims Manager jobs look for? The top searched job categories for Stop Loss Claims Manager jobs are:
Stop Loss Claims Manager jobs near you
Infographic showing various Stop Loss Claims Manager job openings in the United States as of July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

Medical Stop Loss Claims Auditor

EVOLUTION RISK PARTNERS, LLC

Evanston, IL

$75K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 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.