Stop Loss Underwriter Lead
Newark, NJ · On-site
Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Title: Stop Loss Underwriter Lead Location: Newark NJ Duration: 3 Months This position will be the overall ...
Newark, NJ · On-site
Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Title: Stop Loss Underwriter Lead Location: Newark NJ Duration: 3 Months This position will be the overall ...
Newark, NJ · On-site
Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Title: Stop Loss Underwriter Lead Location: Newark NJ Duration: 3 Months This position will be the overall ...
$70K - $85K/hr
Registered Nurse (RN) Supervisor - Integrated Health Management Department: Integrated Health ... stop-loss carriers, and executive leadership. Clinical Responsibilities * Perform Utilization ...
New
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$70K - $85K/hr
Registered Nurse (RN) Supervisor - Integrated Health Management Department: Integrated Health ... stop-loss carriers, and executive leadership. Clinical Responsibilities * Perform Utilization ...
New
New York, NY · On-site
$118K - $178K/yr
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
New York, NY · On-site
$118K - $178K/yr
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
$137K - $150K/hr
The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...
$137K - $150K/hr
The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...
Itasca, IL · On-site
$137K - $150K/hr
The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...
Itasca, IL · On-site
$137K - $150K/hr
The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Itasca, IL · On-site
The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...
Itasca, IL · On-site
The Clinical Risk Specialist RN is responsible for providing high quality case management and ... Reviewing stop-loss cases, making recommendations on potential cost of care, including lasers ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Medical Stop Loss Underwriting Practice Lead - Accident & Health Who we are: American International ... Experience as an RN Medical Case Manager is ideal * Collaborative and strategic mindset with ...
Minneapolis, MN · On-site +1
$90K - $120K/yr
... medical stop-loss portfolio. This role serves as the bridge between clinical knowledge and ... Active Registered Nurse (RN) license required; Bachelor of Science in Nursing (BSN) preferred * 7+ ...
New
Minneapolis, MN · On-site +1
$90K - $120K/yr
... medical stop-loss portfolio. This role serves as the bridge between clinical knowledge and ... Active Registered Nurse (RN) license required; Bachelor of Science in Nursing (BSN) preferred * 7+ ...
New
Minneapolis, MN · On-site +1
$90K - $120K/yr
... medical stop-loss portfolio. This role serves as the bridge between clinical knowledge and ... Active Registered Nurse (RN) license required; Bachelor of Science in Nursing (BSN) preferred * 7+ ...
New
Quick apply
Minneapolis, MN · On-site +1
$90K - $120K/yr
... medical stop-loss portfolio. This role serves as the bridge between clinical knowledge and ... Active Registered Nurse (RN) license required; Bachelor of Science in Nursing (BSN) preferred * 7+ ...
New
South Burlington, VT · On-site
$135K - $155K/yr
Partner with Stop Loss teams on high-cost claim reviews and determinations * Promote end-to-end ... Active Registered Nurse (RN) license * Minimum 5+ years of Utilization Review leadership experience
Quick apply
South Burlington, VT · On-site
$135K - $155K/yr
Partner with Stop Loss teams on high-cost claim reviews and determinations * Promote end-to-end ... Active Registered Nurse (RN) license * Minimum 5+ years of Utilization Review leadership experience
South Burlington, VT · On-site
$135K - $155K/yr
Partner with Stop Loss teams on high-cost claim reviews and determinations * Promote end-to-end ... Active Registered Nurse (RN) license * Minimum 5+ years of Utilization Review leadership experience
Quick apply
South Burlington, VT · On-site
$135K - $155K/yr
Partner with Stop Loss teams on high-cost claim reviews and determinations * Promote end-to-end ... Active Registered Nurse (RN) license * Minimum 5+ years of Utilization Review leadership experience
Exeter, NH · On-site
$135K - $155K/yr
Partner with Stop Loss teams on high-cost claim reviews and determinations * Promote end-to-end ... Active Registered Nurse (RN) license * Minimum 5+ years of Utilization Review leadership experience
Quick apply
Exeter, NH · On-site
$135K - $155K/yr
Partner with Stop Loss teams on high-cost claim reviews and determinations * Promote end-to-end ... Active Registered Nurse (RN) license * Minimum 5+ years of Utilization Review leadership experience
Atlanta, GA · On-site +1
$76K - $104K/yr
... 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 ...
Atlanta, GA · On-site +1
$76K - $104K/yr
... 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 ...
Atlanta, GA · Remote
$76K - $104K/yr
... 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 ...
Atlanta, GA · Remote
$76K - $104K/yr
... 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 ...
Plano, TX · Remote
$85K - $105K/yr
Stop Loss & High-Cost Claims Expertise * Understand and apply stop loss (specific and aggregate ... Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and ...
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Plano, TX · Remote
$85K - $105K/yr
Stop Loss & High-Cost Claims Expertise * Understand and apply stop loss (specific and aggregate ... Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and ...
Stop Loss & High-Cost Claims Expertise * Understand and apply stop loss (specific and aggregate ... Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and ...
Stop Loss & High-Cost Claims Expertise * Understand and apply stop loss (specific and aggregate ... Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and ...
Dallas, TX · On-site
$70K/yr
The RN Clinical Coordinator performs a variety of tasks and coordinates the plans of care for ... Communicate potential catastrophic and stop loss patients * Identify patients related to possible ...
New
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Dallas, TX · On-site
$70K/yr
The RN Clinical Coordinator performs a variety of tasks and coordinates the plans of care for ... Communicate potential catastrophic and stop loss patients * Identify patients related to possible ...
New
$68K - $80.5K
6% of jobs
$80.5K - $93.1K
12% of jobs
$95K is the 25th percentile. Wages below this are outliers.
$93.1K - $105.6K
46% of jobs
$105.6K - $118.2K
6% of jobs
$121.5K is the 75th percentile. Wages above this are outliers.
$118.2K - $130.7K
18% of jobs
$130.7K - $143.3K
7% of jobs
$143.3K - $155.8K
1% of jobs
$155.8K - $168.4K
0% of jobs
$168.4K - $180.9K
0% of jobs
$180.9K - $193.5K
1% of jobs
$193.5K - $206K
2% of jobs
$68K
$114.4K
$206K
As a Stop Loss RN, your typical day involves reviewing high-cost medical claims, verifying the medical necessity of treatments, and assessing policy compliance to determine insurance coverage. You’ll collaborate closely with clinical staff, insurance specialists, and sometimes directly with healthcare providers to gather relevant information and ensure accurate case evaluations. Many Stop Loss RNs also prepare detailed reports and participate in case conferences. This role often combines remote desk work with communications across multidisciplinary teams, creating a dynamic environment well-suited for nurses looking to leverage their clinical expertise in an insurance or administrative setting.
To thrive as a Stop Loss RN, you need in-depth clinical nursing experience, a strong understanding of insurance policies and claims, and RN licensure. Familiarity with medical claims adjudication systems, electronic health records, and utilization review platforms is typically required. Excellent communication, critical thinking, and attention to detail set top performers apart in this role. These skills are important to effectively review complex medical cases, ensure appropriate healthcare coverage, and collaborate with both providers and insurers.
A Stop Loss RN is a registered nurse who reviews medical claims and patient records to evaluate the necessity, accuracy, and cost of healthcare services for insurance companies or employers. They help determine whether claims exceed stop-loss insurance thresholds, which protect insurers or self-funded employers from excessive financial risk. This role involves assessing medical necessity, verifying coding accuracy, and collaborating with case managers, providers, and insurance teams. Strong analytical skills and clinical expertise are essential for making informed decisions on high-cost claims.

Contractor
Medical, Life
Re-posted 13 days ago
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Title: Stop Loss Underwriter Lead
Location: Newark NJ
Duration: 3 Months
This position will be the overall business owner for client's Stop Loss business. This will include Profit & Loss responsibility, business strategy, relationships, contracts, and results of any business partners, operational aspects, pricing and underwriting, relationship with actuarial support, and partnership with Sales/Account Management regarding marketing and sales strategy and results. This position will work cross functionally within client and with outside vendors and consultants to provide direction, ensure results, and build client's capability as a stop loss insurer.
Responsibilities:
Education:
Additional licensing, certifications, registrations:
Competencies:
If you are not interested in looking at new opportunities at this time I fully understand. I would in that case be appreciative of any referrals you could provide from your network of friends and colleagues in the industry.
we do have referral bonus of $500 per candidate, if you refer any of your friends or colleague who are looking out for the same job.
Kind Regards
Dipti Ghodke
Senior Technical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
DIRECT # - 732 - 844 -8719
(W) # 732-549-2030 - Ext - 315
www.irionline.com
LinkedIn: https://in.linkedin.com/in/diptighodke
Gold Seal JCAHO Certified for Health Care Staffing
"INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES" (8th Year in a Row)
Sourced by ZipRecruiter
Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Recruiting and staffing services
51 - 200 Employees
Edison, NJ, US
1996