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Stop Loss Rn Jobs (NOW HIRING)

Swiss Re

Clinical Risk Manager

Alpharetta, GA · 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 ...

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 ...

Ullico

Case Manager

Silver Spring, MD · On-site +1

$76.68K - $115K/yr

Provide cost containment by managing an inventory of Stop Loss claims (involving large case ... Active RN license or APRN license. * Five plus years of significant clinical experience, with ...

Ullico

Case Manager

Silver Spring, MD · Remote

$76.68K - $115K/yr

Provide cost containment by managing an inventory of Stop Loss claims (involving large case ... Active RN license or APRN license. * Five plus years of significant clinical experience, with ...

Ullico

Case Manager

Silver Spring, MD · On-site

$76.68K - $115K/yr

Provide cost containment by managing an inventory of Stop Loss claims (involving large case ... Active RN license or APRN license. * Five plus years of significant clinical experience, with ...

Symetra

Manager - Medical Risk Consultants - Remote

$96.70K - $161.20K/yr

Active RN License required. * 8+ years of stop loss, medical risk management experience required. * Prior people leadership experience with a focus on coaching and development * Strong understanding ...

Point C

OR

$20 - $25.75/hr

... stop-loss carrier, and community resources * Assess a patient's unmet health and social needs ... Current standing as a registered nurse (RN) or licensed practical nurse (LPN) required * 5 years of ...

Jzanus Consulting

Nurse Auditor

Garden City, NY · On-site

$87K/yr

Registered Nurse licensed in New York preferred. 3+ years' experience in hospital setting preferred ... HMO/PP, EOB, stop loss, etc.) and payment methodologies. Excellent communication skills required.

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How much do stop loss rn jobs pay per year?

As of May 31, 2026, the average yearly pay for stop loss rn in the United States is $114,374.00, according to ZipRecruiter salary data. Most workers in this role earn between $98,500.00 and $126,500.00 per year, depending on experience, location, and employer.

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
Infographic showing various Stop Loss Rn job openings in the United States as of May 2026, with employment types broken down into 8% As Needed, 52% Full Time, 31% Part Time, and 9% Contract. Highlights an 97% Physical, and 3% Remote job distribution, with an average salary of $114,374 per year, or $55 per hour.
Clinical Risk Manager

Clinical Risk Manager

Swiss Re

Alpharetta, GA • Hybrid

$84K - $140K/yr

Other

Posted 14 days ago

Job description

Swiss Re uses a hybrid work model requiring at least three days in the office each week.

This position can be based near one of our Swiss Re offices, including (but not limited to) Alpharetta, GA -- Windsor, CT -- Schaumburg, IL. 

We have an excellent opportunity for an experienced Clinical Risk Manager to join our team in Swiss Re's Accident & Health division!

About the Role:

This position requires a strong clinical background in disease state management/case management experience.  A background in a Clinical Risk Management position is encouraged but will consider qualified candidates especially those with an oncology or cardiology background.  This position is ideal for applicants looking to enter the insurance sector in a nurse consultant role.

In this position you have the responsibility to use your knowledge and experience to project expected treatment costs based on ICD 9 / ICD 10 codes, current treatment plan and other pertinent medical information.

Principal responsibilities include:

  • Review medical conditions and respond with a cost analysis coordinated to the Stop Loss case characteristics.  Including the review and assessment of large claim reports, shock claim summary reports, trigger reports and large case management notes
  • Identify high risk associated with individuals and communicate required stop loss cost analyzation of current clinical conditions and future cost projections
  • Utilize provided clinical resoources such as Predict Dr., NCCN, NORD, and CDC 
  • Supply and manage documentation with clinical summary and estimated cost of services for each individual identified as at risk

About the Team:

The Clinical Risk team brings value to Swiss Re working in close collaboration with Underwriters to determine and evaluate potential risk and associated costs of projected treatments and care.  We are a welcoming team of nurses who are passionate about what they do.  Diversity and Inclusion are a part of our winning culture.  We believe that our individual performances contribute to the success of the team.  Come join us and be a part of something big!

About You:

You bring your strong analytical and problem-solving expertise!  Your excellent interpersonal skills enable you to successfully navigate cross-functional collaboration.  You have an ability to prioritize well and work independently with little direct supervision, while handling numerous projects at once.

Additional requirements include:

  • 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 producing work that is highly accurate, shows attention to detail, and reflects well on the organization
  • Proven experience managing mulitple projects and working well while handling large volumes of work (with deadlines)
  • Excellent written and verbal communication skills
  • Computer proficiency, specifically strong typing skills and Internet research skills, must have a clear understanding of Microsoft Word, Microsoft Office and Excel

The estimated base salary range for this position is $84,000 to $140,000.  The specific salary offered for any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation.

About Swiss Re

Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 14,000 employees across the world.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.

We may use AI-powered tools to support the review and evaluation of applications for this position. These tools provide additional insights to our recruitment teams, but all hiring decisions are carefully reviewed and made by people. To learn more about how we use AI in recruitment and how we handle your personal data, please review our Data Privacy Statement before applying.

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Reference Code: 137700 

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