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Stop Loss Rn Jobs in Texas (NOW HIRING)

Matrix Pharmacy Group

Registered Nurse

Dripping Springs, TX · On-site

$28 - $45/hr

Registered Nurse (RN) Location: Dripping Springs, TX Are you a compassionate and skilled Registered ... Support weight loss and hormone optimization programs under provider guidance * Assist with patient ...

Matrix Pharmacy Group

Registered Nurse

Dripping Springs, TX · On-site

$28 - $45/hr

Registered Nurse (RN) Location: Dripping Springs, TX Are you a compassionate and skilled Registered ... Support weight loss and hormone optimization programs under provider guidance * Assist with patient ...

Cynet Health

RN (Registered Nurse)

Bryan, TX · On-site

$2.5K/wk

Registered Nurse Specialty: Operating Room Duration: 12 weeks Shift: Monday to Friday Hours per ... Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with ...

Golden Plains Community Hospital

RN

Borger, TX · On-site

$2.3K/wk

Registered Nurse Specialty: Operating Room Duration: 13 weeks Shift: 8 Hour Days Hours per Shift: 7 ... Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with ...

TLC NURSING SERVICES

RN

Waxahachie, TX · On-site

$2.2K/wk

... Travel Offering Nursing Profession RN Specialty Registered Nurse Job ID 18809597 Job Title RN ... You can reply "STOP" anytime to unsubscribe or send e-mail at nexusqueries@talent4health.com.

TLC NURSING SERVICES

RN

Fort Worth, TX · On-site

$2.7K/wk

Registered Nurse Profession: RN Specialty: Clinical-Nursing Duration: 13 weeks Shift: AM Hours per ... Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with ...

PHS Presbyterian Hospital

RN

Dallas, TX · On-site

$2.7K/wk

Registered Nurse (RN) Certifications: ACLS/BLS Must-Have: 2+ years of experience in nursing ... Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with ...

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Stop Loss Rn information

How to make $200,000 as a nurse?

As a nurse, reaching a $200,000 salary typically involves gaining advanced certifications, specializing in high-demand areas like anesthesia or nurse practitioner roles, and working in settings such as travel nursing or private agencies that offer higher pay. Increasing experience, working overtime, and pursuing leadership or administrative positions can also boost earnings.

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.

How to make an extra $2000 a month as a nurse?

As a nurse, increasing income by $2000 monthly can involve taking on overtime shifts, working in high-demand specialties, or pursuing per diem or travel nursing assignments that offer higher pay rates. Developing specialized skills or certifications, such as in critical care or anesthesia, can also qualify you for higher-paying roles or bonuses.

What jobs pay 4000 a week without a degree?

A Stop Loss RN can potentially earn around $4,000 weekly through high-volume, specialized roles in healthcare, especially with experience and certifications. Other high-paying jobs without a degree include sales positions, real estate agents, and certain skilled trades like commercial diving or oilfield work, which often rely on experience and performance bonuses. These roles typically require strong skills, certifications, or licenses rather than formal degrees.

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 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 does a stop loss nurse do?

A stop loss nurse manages and monitors insurance claims related to stop loss coverage, which protects employers from high-cost healthcare expenses. They review medical claims, ensure compliance with policy terms, and collaborate with healthcare providers and insurance companies to process claims accurately. Strong knowledge of healthcare billing, insurance policies, and attention to detail are essential for this role.
What are popular job titles related to Stop Loss Rn jobs in Texas? For Stop Loss Rn jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Stop Loss Rn jobs in Texas look for? The top searched job categories for Stop Loss Rn jobs in Texas are:
What cities in Texas are hiring for Stop Loss Rn jobs? Cities in Texas with the most Stop Loss Rn job openings:
Stop Loss Rn jobs near you
Infographic showing various Stop Loss Rn job openings in Texas as of July 2026, with employment types broken down into 74% Full Time, 23% Part Time, 1% Temporary, and 2% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.
Senior Claims Analyst - Hospital Bill Review

Senior Claims Analyst - Hospital Bill Review

SmartLight Analytics

Plano, TX • On-site, Remote

Full-time

Posted 11 days ago

Job description

We are seeking an experienced Senior Claims Analyst with deep expertise in hospital claims adjudication, stop loss reporting, high-cost/catastrophic claims, and DRG (Diagnosis-Related Group) reimbursement methodology. This individual will analyze itemized hospital bills and claims data to identify billing errors, coding discrepancies, DRG misassignments, and other overpayment opportunities, then work directly with claims administrators on behalf of our ASO clients to secure claim adjustments, recoveries, and repricing.
This is a highly analytical, client-facing role requiring both technical claims expertise and strong negotiation/communication skills.
Key Responsibilities
Claims Analysis & Review
  • Perform detailed audits of hospital and facility claims, including itemized bills, UB-04 claim forms, medical records, and remittance advices, to validate billing accuracy.
  • Analyze DRG assignments and coding to identify DRG upcoding, unbundling, duplicate billing, and other irregularities that affect reimbursement.
  • Review high-cost and catastrophic claims (typically $100K+) to identify overpayments, contract misapplication, and opportunities for negotiated adjustments.
  • Evaluate claims against plan documents, provider contracts, reference-based pricing methodologies, and CMS guidelines to determine appropriate reimbursement.
Stop Loss & High-Cost Claims Expertise
  • Understand and apply stop loss (specific and aggregate) provisions, laser terms, and reporting requirements as they relate to claim adjustments and client financial exposure.
  • Coordinate with stop loss carriers and reinsurers as needed to ensure adjustments and recoveries are properly reflected in stop loss reimbursement calculations.
  • Identify claims nearing or exceeding specific deductible thresholds and prioritize review accordingly.
Client Advocacy & Claims Administrator Negotiation
  • Serve as the subject matter expert and advocate on behalf of ASO clients in disputes with claims administrators (TPAs) and carriers regarding claim payment accuracy.
  • Prepare clear, well-documented findings packages (clinical, contractual, and coding rationale) to support requested claim adjustments and appeals.
  • Lead or support negotiations with claims administrators to reach adjusted payment resolutions.
  • Track disputes through resolution, escalating unresolved cases appropriately and maintaining strong working relationships with TPA claims and provider relations teams.
Data & Reporting
  • Analyze large claims data sets to identify trends, outlier claims, and systemic overpayment patterns across client populations.
  • Build and maintain claim tracking logs, savings reports, and client-facing summaries of identified and recovered savings.
  • Partner with internal data/analytics teams to refine claim-flagging logic and improve identification of high-value review opportunities.
Required Qualifications
  • 5+ years of experience in hospital claims analysis, medical bill review, claims auditing, or payment integrity, with direct exposure to self-funded/ASO plans.
  • Strong working knowledge of DRG methodology (MS-DRG/APR-DRG), UB-04 billing, ICD-10-CM/PCS, CPT/HCPCS coding, and hospital chargemaster structures.
  • Demonstrated understanding of stop loss insurance, including specific/aggregate deductibles, laser provisions, and how claim adjustments impact stop loss reimbursement.
  • Experience analyzing high-cost/catastrophic claims and identifying overpayment or billing error patterns.
  • Prior experience interacting with or negotiating against TPAs, insurance carriers, or claims administrators on disputed claims.
  • Proficiency with claims data analysis tools (Excel required; SQL, Access, or claims analytics platforms a plus)
  • Excellent written and verbal communication skills, with the ability to build persuasive, well-supported adjustment requests and appeals.
  • Strong attention to detail and ability to manage a high volume of complex claims simultaneously.
Preferred Qualifications
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Bill Review Specialist, or similar credential.
  • Prior experience at a TPA, insurance carrier, hospital billing/coding department, or payment integrity/cost containment vendor.
  • Familiarity with reference-based pricing (RBP), Medicare fee schedules, and out-of-network claims repricing.
  • Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and medical necessity issues.
What Success Looks Like
  • Consistent identification of material overpayments and billing errors on high-cost hospital claims.
  • Strong track record of securing favorable claim adjustments through negotiation with claims administrators.
  • Clear, professional communication that strengthens client trust and TPA relationships.
  • Measurable contribution to client savings and stop loss cost containment.

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