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Stop Loss Rn Jobs in Illinois (NOW HIRING)

Swiss Re

Clinical Risk Manager

Schaumburg, IL · Hybrid

$84K - $140K/yr

Minimum of Associate or Bachelor's degree in nursing with at least 1 year of Stop Loss Nursing experience * Must have up to date registered nurse (RN) license * Able to demonstrate a track record of ...

IntelyCare

Registered Nurse (RN)

Taylorville, IL

Start Your Nursing Career with Us as a Registered Nurse (RN)! Location: Taylorville Skilled Nursing ... Apply online or stop by anytime for a walk-in application. Taylorville Skilled Nursing & Rehab 800 ...

Hallmark of Pekin

Registered Nurse (RN)

Pekin, IL · On-site

$42 - $50/hr

) Join Our Team as a Registered Nurse (RN) Location: Hallmark Healthcare of Pekin, Pekin, IL Shift ... Apply online or stop by in person today: 2501 Allentown Road, Pekin, IL 61554 Apply Online: We look ...

FHN

RN (Registered Nurse)

Freeport, IL

$1.98K/wk

Details Client Name FHN Memorial Hospital Job Type Travel Offering Nursing Profession RN Specialty ... Email or text HELP for more info, or STOP to unsubscribe.

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Stop Loss Rn information

What is a Stop Loss RN job?

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.

What are the key skills and qualifications needed to thrive in the Stop Loss Rn position, and why are they important?

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.

What are the typical daily responsibilities of a Stop Loss RN?

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.
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Stop Loss Rn jobs near you
Stop Loss Coordinator

Stop Loss Coordinator

BCS Financial Corporation

Villa Park, IL • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Stop Loss Coordinator

The Stop Loss Coordinator provides support to the Stop Loss Underwriting department. The role is responsible for the management of the stop loss proposal inbox, quote set-up, and manipulating electronic files for data entry. This position manages the quote activity process and ensures that quotes are released in a timely manner.

This position will report to the AVP, Accident & Health Underwriting

Essential Elements
  • Quote Management- Manage quote inbox by prioritizing requests, meeting quote turnaround times and answering all questions related to the quote
  • Customer Service- Troubleshoot and communicate effectively with external and internal partners to resolve quote requests issues and concerns
  • File Management- Set up both electronic and hard copy file for the Underwriter, review file for completeness and request additional data, setting up nurse reviews
  • Onboarding Support- Assist the Underwriting team with new and sold case business processing
  • Reporting- Assist with the preparation of monthly reports
Requirements

Education and Certifications

  • Associate's degree or commensurate experience preferred

Experience

  • 2 years of experience in the health insurance industry or an equivalent field preferred
  • Proficiency with computers and standard software applications such as Microsoft Office, including Excel and Word required

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