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Stop Loss Jobs in Ohio (NOW HIRING)

JCW Group

Medical Underwriter

Cincinnati, OH · On-site

A well established insurance carrier with a long track record of stability is looking to add a Medical Stop Loss professional to its underwriting team in Cincinnati. This is a great opportunity to ...

Medical Mutual

Account Administrator-Small Group

Brooklyn, OH · On-site

$18.75 - $25.25/hr

We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Provides administrative support to account ...

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Stop Loss information

See Ohio salary details

$14

$21

$31

How much do stop loss jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for stop loss in Ohio is $21.28, according to ZipRecruiter salary data. Most workers in this role earn between $17.36 and $24.47 per hour, depending on experience, location, and employer.

What is a stop loss?

A Stop Loss job typically involves reviewing, analyzing, and managing stop-loss insurance policies, which help protect employers and insurers from catastrophic claims. Professionals in this role assess claims, set appropriate coverage limits, and work with underwriters, brokers, and policyholders to mitigate financial risk. They may also monitor trends in healthcare costs and claims data to adjust policies accordingly.

What are the key skills and qualifications needed to thrive in the stop loss position, and why are they important?

To thrive as a Stop Loss specialist, you need expertise in risk assessment, insurance policy analysis, and a strong understanding of healthcare or reinsurance principles, typically supported by a bachelor’s degree in finance, insurance, or a related field. Familiarity with industry platforms such as policy administration systems and strong proficiency in Excel or actuarial software are often required. Exceptional analytical thinking, attention to detail, and effective communication skills are highly valued for collaboration and client interactions. These abilities enable precise risk evaluation, thorough policy management, and the delivery of tailored solutions to clients and stakeholders.

What are some typical challenges faced by stop loss specialists in their day-to-day work?

Stop Loss specialists frequently encounter challenges such as balancing the need for thorough risk assessment with tight deadlines, interpreting complex claims data, and staying updated with changing regulations and market trends. They often manage multiple clients or policies simultaneously, requiring strong organizational and time-management skills. Additionally, collaborating with underwriting, claims, and broker teams is essential to ensure accurate and comprehensive coverage solutions. Developing effective communication strategies to explain policy details and recommendations to clients is key for success in this role.

What are the most commonly searched types of Stop Loss jobs in Ohio?

The most popular types of Stop Loss jobs in Ohio are:

What are popular job titles related to Stop Loss jobs in Ohio?

For Stop Loss jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Stop Loss jobs in Ohio look for?

The top searched job categories for Stop Loss jobs in Ohio are:

Stop Loss jobs near you
Infographic showing various Stop Loss job openings in Ohio as of August 2026, with employment types broken down into 3% Internship, 84% Full Time, and 13% Part Time. Highlights an 97% In-person, and 3% Hybrid job distribution, with an average salary of $44,265 per year, or $21.3 per hour.

Director of Claims & Stop-Loss Transformation - REMOTE

S&S Healthcare

Cincinnati, OH • On-site

$120K - $160K/yr

Other

Re-posted yesterday

Job description

Reflect Health is the evolution of S&S Health, a trusted independent third-party administrator founded in 1994 to meet the growing need for access, simplified connectivity, and benefits administration. Headquartered in Mason, OH, we have built a reputation based on innovation, service excellence, and a deep understanding of how to drive better outcomes at lower cost. Over the years, we grew into a national presence serving employers, TPAs, health systems, and benefit consultants across all 50 states. We developed proprietary claims technology, expanded our offerings to include level-funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members.

We are seeking a Director of Claims & Stop-Loss Transformation to lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms. Reporting to the Chief of Staff, Transformation Office, this role serves as a transformation leader responsible for assessing current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives that improve scalability, efficiency, quality, and organizational performance. This role will partner closely with Executive Leadership, Claims Operations, Stop-Loss, Technology, Finance, Compliance, Client Success, and operational teams to evaluate current performance, redesign workflows, establish accountability structures, and execute transformation initiatives that enable operational excellence. The ideal candidate is an experienced healthcare transformation with expertise in self-funded health plan administration, claims operations, stop-loss administration, business process redesign, technology enablement, operational analytics, and organizational change management. This individual must be comfortable operating as both a strategic transformation leader and a hands-on operator capable of driving measurable improvements across core TPA functions.

Responsibilities

Transformation Strategy & Future-State Design

Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends.
Conduct structured assessments to identify operational gaps, root causes, scalability challenges, and improvement opportunities.
Develop future-state operating models, transformation strategies, and implementation roadmaps aligned with Reflect Health’s long-term growth objectives.
Establish transformation priorities, milestones, implementation plans, and success measures.
Provide executive leadership with strategic recommendations, business cases, and investment priorities for transformation initiatives.
Establish baseline KPIs, operating cadences, and accountability structures to measure transformation progress.

Business Process Transformation

  • Lead enterprise process redesign initiatives focused on simplifying workflows, reducing administrative complexity, improving operational scalability, and enhancing service performance.
  • Conduct process assessments, workflow analysis, process mapping, and root-cause evaluations to identify improvement opportunities. Establish transformation priorities, milestones, and implementation plans.
  • Redesign workflows and operating models to improve efficiency, quality, and consistency, as well as the development of standardized procedures, governance models, and operational accountability structures.
  • Facilitate cross-functional design sessions to develop sustainable future-state processes.

Claims & Stop-Loss Modernization

  • Lead modernization efforts across claims and stop-loss administration, including specific and aggregate claim processes, reporting workflows, filing timelines, and recovery processes
  • Evaluate end-to-end claims workflows, including intake, adjudication, payment, quality processes, and exception management, to identify opportunities for improvement.
  • Identify opportunities to reduce claims errors, rework, pend volume, manual intervention, and service-level misses.
  • Support initiatives that improve claims effectiveness, operational consistency, automation, and organizational readiness.
  • Partner with Operations leaders to improve claims quality frameworks, root-cause feedback loops, and continuous improvement practices.
  • Assess opportunities to improve plan configuration discipline, auto-adjudication rates, eligibility administration, and EDI processes.
  • Support automation opportunities for high-dollar claim identification, filing triggers, and exception management.

Technology Enablement & Automation

  • Partner with Technology teams to translate business opportunities into system enhancements, automation opportunities, platform improvements, and data-driven solutions.
  • Support evaluation of technology capabilities and recommend enhancements that enable future-state operations.
  • Identify opportunities for workflow automation, TPA platform optimization, EDI improvements, and operational enablement solutions.
  • Drive alignment between business strategy, operational needs, and technology investments.
  • Support development of operational dashboards and reporting capabilities that improve leadership visibility into performance trends, risks, and opportunities.

Transformation Governance & Measurement

  • Establish transformation governance frameworks, initiative tracking, executive reporting, and benefit realization processes.
  • Define transformation success measures related to claims performance, operational efficiency, stop-loss effectiveness, automation adoption, and service improvements.
  • Develop executive-level dashboards and communications related to transformation initiatives.
  • Provide leadership visibility into progress, risks, dependencies, and outcomes.

Change Management & Stakeholder Alignment

  • Lead organizational change efforts required to successfully implement new processes, technologies, and operating models.
  • Build alignment among teams, and facilitate communication, adoption planning, and organizational readiness activities.
  • Partner with operational leaders to ensure redesigned processes are successfully implemented and sustained.

Qualifications

Industry Experience

  • Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance organization.
  • Deep understanding of claims operations, stop-loss administration, employer-sponsored health plans, and healthcare administration workflows.
  • Experience with self-funded plan mechanics, ASO arrangements, stop-loss contract structures, and carrier relationships preferred.
  • Knowledge of employer group, broker, TPA, and stop-loss carrier dynamics.

Transformation Leadership

  • Demonstrated success leading healthcare transformation initiatives, business process redesign, operational modernization, and enterprise change programs.
  • Experience developing future-state operating models, transformation roadmaps, and scalable operating processes.
  • Proven ability to identify operational gaps, define improvement opportunities, and drive implementation across organizational boundaries.
  • Ability to influence executive stakeholders and lead complex initiatives involving multiple business functions.

Process & Technology Expertise

  • Experience partnering with Technology teams to implement workflow automation, platform enhancements, data improvements, and operational enablement solutions.
  • Strong understanding of healthcare administration systems, EDI transactions, claims workflows, and operational processes.
  • Experience leveraging operational data, reporting tools, and analytics to identify root causes and support business decisions.
  • Familiarity with claims technology platforms, workflow tools, automation solutions, and operational reporting capabilities.

Claims & Stop-Loss Expertise

  • Experience improving claims accuracy, workflow efficiency, operational performance, and service-level outcomes.
  • Understanding of stop-loss administration processes, including specific and aggregate claims, filing requirements, recoveries, and carrier coordination.
  • Familiarity with healthcare compliance requirements, including No Surprises Act, ACA reporting, and Continuity of Care requirements preferred.

Leadership & Communication

  • Strong analytical, strategic thinking, and problem-solving capabilities.
  • Excellent communication and stakeholder management skills.
  • Ability to translate complex operational challenges into actionable transformation strategies.
  • Ability to operate effectively in environments requiring cross-functional influence, organizational change, and continuous improvement.

Reflect Health is committed to providing a safe and secure workplace for all employees. All final candidates will be subject to background checks and drug screening as part of the hiring process.