Stop Loss Insurance Jobs in Seattle, WA (NOW HIRING)

POSITION SUMMARY:

The Stop-Loss Analyst manages Excess Loss / Stop-Loss insurance contracts for self-insured clients. This role is responsible for end-to-end contract monitoring, claims auditing, timely submission of specific and aggregate stop-loss reimbursements, funding coordination, and contract renewal reporting.

The ideal candidate is organized, proactive, self-directed, and exceptionally responsive, possessing strong claims knowledge and an acute awareness of strict stop-loss carrier timeline requirements. Serving as a crucial bridge between Claims, Medical Management, Account Management Healthcare Analytics, external vendors, and Stop-Loss carriers, the Analyst ensures full contract compliance, mitigates financial risk, and drives claims to reimbursement with accuracy and urgency.

Individuals who thrive at First Choice Health exhibit the following success skills –

Caring, Transparency, Collaboration, Relentlessness, and Innovation.

RESPONSIBILITIES:1. Claims Monitoring, Research & High-Dollar Tracking

• Proactive Monitoring: Conduct weekly reviews of claims activity using internal tracking software and analytical tools to identify claimants approaching or reaching Stop-Loss reimbursement triggers.

• Clinical & Diagnosis Tracking: Partner closely with the Medical Management team to track high-cost clinical diagnoses, transplant cases, specialty pharmacy utilization, and NICU stays for early stop-loss disclosure.

2. Contract, Submission & Timeline Management

• Timeline Enforcement: Manage strict carrier notification, submission, run-out, and Request for Information (RFI) deadlines to prevent claim denials.

• Contract Management: Stay current on client-specific Stop-Loss contract parameters and update internal tracking systems to maintain precise reporting data.

• Package Submission: Assemble and file complete, audit-ready reimbursement packages—including UB-04/CMS-1500 forms, EOBs, enrollment records, proof of payment, and clinical notes—for specific and aggregate claims.

3. Financial Tracking, Auditing & Funding Coordination

• Funding & Reconciliation: Track the receipt of incoming Stop-Loss funds, reconcile carrier reimbursements against submitted amounts, and maintain clear audit ledgers.

• Claims Release Coordination: Partner with the Claims Department to request advance funding when applicable and coordinate the release of held claims once stop-loss payments are received.

• External Collaboration: Coordinate with outside vendors for third-party liability, subrogation, and COBRA-related tasks impacting stop-loss eligibility.

4. Reporting, Strategy & Internal Advocacy

• Reporting & Renewals: Prepare and distribute monthly aggregate tracking reports, status logs, and renewal documentation to Stop-Loss carriers and internal leadership.

• Internal Subject Matter Expert (SME): Serve as the central point of contact for Stop-Loss inquiries, providing guidance across internal departments.

• Process Improvement: Collaborate with internal development teams to identify, test, and guide enhancements for proprietary analytical and tracking tools.

• Automation: Drive enhancements to support Stop-Loss tracking and submission automation

• Other duties as assigned

QUALIFICATIONS:Core Requirements (Must-Haves)

• Experience: 3–5 years of claims handling, stop-loss administration, or related TPA (Third-Party Administrator) experience.

• Work Style: Highly organized, detail-oriented, self-directed, proactive, and responsive—able to manage priorities independently, anticipate carrier inquiries, and execute with urgency under tight deadline constraints.

• Technical Aptitude: Demonstrated ability to interpret complex Stop-Loss/Reinsurance contracts, understand claims processing, and Medical Management workflows.

• Data Security & Compliance: Proficient in securely handling Protected Health Information (PHI) and managing encrypted electronic file transfers in strict accordance with HIPAA.

• Software & Analytics: Proficiency with Microsoft Office (advanced Excel skills like VLOOKUPs and pivot tables) or Google Workspace.

• Communication Skills: Strong analytical problem-solving skills with clear, concise written and verbal communication for cross-departmental and carrier interactions.

Preferred Qualifications (Nice-to-Haves)

• Education: Bachelor’s degree in Business, Finance, Healthcare Administration, or a related field.

• Background: Strong background in auditing, financial reconciliation, or mathematics with exceptional attention to detail.

• Industry Knowledge: Deep familiarity with medical terminology, standard coding formats (CPT, ICD-10, UB-04, CMS-1500), reference-based pricing (RBP), and COBRA rules.