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Stop Loss Rn Jobs in New Jersey (NOW HIRING)

Stability Healthcare

Travel RN

Basking Ridge, NJ · On-site

They also provide education and counseling to patients and their families about end-of-life care, grief and loss, and other related topics. Job Requirements : A hospice registered nurse must be ...

Mission Hospital

RN - Oncology

Newark, NJ · On-site

$478.50/wk

... RN Specialty Oncology Job ID 37823812 Job Title RN - Oncology Weekly Pay $478.5 Shift Details Shift ... can reply STOP to cancel and HELP for help) Client Details Address 201 Lyons Avenue at Osborne ...

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Stop Loss Rn information

What is a Stop Loss RN?

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 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.

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.

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Stop Loss Rn jobs near you
Infographic showing various Stop Loss Rn job openings in New Jersey as of August 2026, with employment types broken down into 3% As Needed, 59% Full Time, 16% Part Time, and 22% Contract. Highlights an 99% Physical, and 1% Remote job distribution.

Stop Loss Underwriter Lead

Integrated Resources INC

Newark, NJ • On-site

Contractor

Medical, Life

Re-posted 4 days ago

Job description

Company Description

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 Description

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:

  • Act as business owner, P&L owner, and thought leader in strategically and tactically designing and implementing client's stop loss products, business strategy, business partnerships, operational approach, sales & marketing approach and results, pricing and policies.
  • Build consensus with leadership of Sales/Account Management, Actuarial, Underwriting, and Enrollment & Billing.
  • Own relationships, contracts, and results of business partners.
  • Provide insight into the stop loss market from a competitive standpoint including but not limited to products offered and marketing.
  • Recommend initial approach and ongoing changes to stop loss position.
  • Include recommendations related to partners and tools (e.g., administrative and pricing).
  • Determine financial impact of recommended approaches to revenue generation efforts and P&L.
  • Maintain, update, enforce and test client's underwriting, actuarial, pricing, and marketing policies and procedures related to stop loss.
  • Train enterprise staff as necessary on stop loss and ongoing changes in policies and procedures.
  • Ensure regulatory compliance of stop loss products, contracts, and pricing.
  • Champion the needs of the Stop Loss business within the Enterprise, securing enterprise resource support and funding as necessary.
  • Medical stop-loss underwriting specifically needed. Other industry underwriting or stop-loss underwriting would not be applicable experience.


Qualifications

Education:

  • Four year college degree required.
  • Concentration in Finance or other business/analytical area a plus.
  • Prefer MBA.

Additional licensing, certifications, registrations:

  • None required. Prefer FSA/ASA.
  • Requires a minimum of 8 years stop loss industry experience.
  • Experience negotiating with external vendors required.
  • Experience leading for change is required.
  • Actuarial or underwriting expertise in stop loss required.
  • Consulting experience desired.

Competencies:

  • Requires creative thinking, strong leadership, communication, analytical and financial technical skills.
  • Must understand complex financial concepts.
  • Requires excellent interpersonal skills, the ability to interact cross functionally, build relationships, and drive change.
Additional Information

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)

Integrated Resources logo

About Integrated Resources

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.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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