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Work From Home Stop Loss Rn Jobs (NOW HIRING)

Allied

Stop Loss Claims Specialist II-Specific

Chicago, IL · On-site +1

$24 - $26/hr

POSITION SUMMARY The Stop Loss Claim Specialist II (Specific) is responsible for preparing and ... Our remote friendly culture offers flexibility and the comfort of working from home, while also ...

Allied

Stop Loss Claims Specialist I-Specific

Chicago, IL · On-site +1

$23 - $24/hr

POSITION SUMMARY The Stop Loss Claim Specialist is responsible for preparing and filing medical ... Our remote friendly culture offers flexibility and the comfort of working from home, while also ...

Allied

Stop Loss Claims Specialist I-Aggregate

Chicago, IL · On-site +1

$23 - $24/hr

POSITION SUMMARY The Stop Loss Claim Specialist is responsible for preparing and filing medical ... Our remote friendly culture offers flexibility and the comfort of working from home, while also ...

Allied

Stop Loss Revenue Associate

Chicago, IL · On-site +1

$20 - $23/hr

POSITION SUMMARY The Stop Loss Revenue Associate (Revenue Associate) will engage in various ... Our remote friendly culture offers flexibility and the comfort of working from home, while also ...

Berkley

Stop Loss Underwriter

Indianapolis, IN · Remote

$90K - $110K/yr

You will work closely with more seasoned underwriting staff to develop more advanced underwriting ... Establish the basics of medical underwriting by training with and learning from the Company ...

Berkley

Stop Loss Underwriter

Indianapolis, IN · Remote

$90K - $110K/yr

You will work closely with more seasoned underwriting staff to develop more advanced underwriting ... Establish the basics of medical underwriting by training with and learning from the Company ...

New

NFP Corp

Senior Consultant, Stop Loss

NY · Remote

$77K - $132K/yr

NFP, an Aon company, is a multiple Best Places to Work award winner in Business Insurance. We are ... The Senior Stop Loss Consultant is a subject-matter expert responsible for leading complex stop ...

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Work From Home Stop Loss Rn information

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$68K

$114.4K

$206K

How much do work from home stop loss rn jobs pay per year?

As of Jul 13, 2026, the average yearly pay for work from home 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 the difference between Work From Home Stop Loss Rn vs Work From Home Case Manager?

AspectWork From Home Stop Loss RnWork From Home Case Manager
CredentialsRN license, certifications in insurance or risk managementRN license, case management certification
Work EnvironmentHome-based, insurance and healthcare settingsHome-based, healthcare and insurance industries
Industry UsageInsurance companies, healthcare providersInsurance companies, healthcare organizations
Job FocusManaging stop loss insurance claims and riskCoordinating patient care and insurance processes

While both roles require RN licensure and healthcare knowledge, the Work From Home Stop Loss Rn focuses on managing insurance claims related to stop loss coverage, emphasizing risk assessment. In contrast, the Work From Home Case Manager concentrates on coordinating patient care and insurance processes. Both roles are home-based and serve the healthcare and insurance industries, but their primary responsibilities differ significantly.

What is a Work From Home Stop Loss RN?

A Work From Home Stop Loss RN is a registered nurse who works remotely, typically for insurance companies or third-party administrators, to review medical claims associated with stop loss insurance policies. Their main responsibility is to assess the medical necessity and appropriateness of claims that exceed certain thresholds, helping employers and insurers manage high-cost healthcare claims. These nurses use their clinical expertise to analyze medical records, communicate with providers, and ensure that claims are processed accurately and efficiently. Working from home allows them to perform these tasks virtually, often using secure digital platforms.

What are some common challenges faced by Work From Home Stop Loss RNs, and how can they be addressed?

Work From Home Stop Loss RNs often face challenges related to remote communication, maintaining up-to-date clinical knowledge, and managing a high volume of case reviews. Since collaboration is primarily virtual, it's important to develop strong written and verbal communication skills to effectively coordinate with physicians, case managers, and insurance teams. Staying current with clinical guidelines and leveraging digital tools for documentation and workflow management can help streamline responsibilities and ensure accurate decision-making. Building a structured daily routine and proactively seeking support from team leads or mentors can also help address feelings of isolation and ensure ongoing professional growth.

What are the key skills and qualifications needed to thrive as a Work From Home Stop Loss RN, and why are they important?

To thrive as a Work From Home Stop Loss RN, you need a current RN license, strong clinical assessment skills, and experience in utilization review or case management. Familiarity with health insurance systems, stop loss claims processes, and electronic medical record (EMR) platforms is typically required. Excellent attention to detail, critical thinking, and effective written communication are crucial soft skills for remote collaboration and accurate documentation. These abilities ensure accurate claim evaluations, regulatory compliance, and efficient coordination with insurers and healthcare providers.
More about Work From Home Stop Loss Rn jobs
What cities are hiring for Work From Home Stop Loss Rn jobs? Cities with the most Work From Home Stop Loss Rn job openings:
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Work From Home Stop Loss Rn jobs near you
Infographic showing various Work From Home Stop Loss Rn job openings in the United States as of July 2026, with employment types broken down into 73% Full Time, 20% Part Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $114,374 per year, or $55 per hour.
Stop Loss Claims Specialist II-Specific

Stop Loss Claims Specialist II-Specific

Allied

Chicago, IL • On-site, Remote

$24 - $26/hr

Full-time

Medical, Dental, Vision, Life, PTO

Posted 3 days ago

Job description

POSITION SUMMARY
The Stop Loss Claim Specialist II (Specific) is responsible for preparing and filing medical stop loss claims for reimbursement with stop loss carriers for individual stop loss (Specific) coverage. Additional duties include following up with the various carriers to ensure reimbursements are received timely and in full. Further responsibilities include the appeals of denied and reduced claim reimbursements, along with retaining the appropriate documentation needed to support the reimbursement request. The Stop Loss Claim Specialist II will be responsible for training team members. In addition, duties will include maintaining a relationship with priority carriers.
ESSENTIAL FUNCTIONS
  • Compile and submit claim reports and the necessary documentation to file a stop loss claim.
  • Monitor the status of claims assigned and follow up with stop loss carriers.
  • Answer questions and requests from stop loss carriers for additional information.
  • Communicate with other internal departments to resolve claim issues.
  • Appeal the denials or reduction of reimbursements by the stop loss carrier.
  • Filing Stop Loss Claims with priority carriers.
  • Coordinating with other Stop Loss Team Members regarding priority claims.
  • Filing high dollar claims.
  • Retain necessary documents required by carriers from providers.
  • Training team members regarding departmental process and workflows.
  • Other duties as assigned.

EDUCATION
  • High School Diploma or GED required.
  • College degree preferred.

EXPERIENCE AND SKILLS
  • Minimum 2 years of stop loss claim filing experience, required.
  • Medical claims experience required.
  • Accounting or Finance background a plus.
  • Proficient with Microsoft Office Suite or related software.
  • Strong analytical and problem solving skills.
  • Excellent verbal and written communication skills.
  • Excellent organizational skills and attention to detail.
  • Excellent time management skills with a proven ability to meet deadlines.

POSITION COMPETENCIES
  • Accountability
  • Communication
  • Customer Service Orientation
  • Functional/Technical Skills
  • Quality Focus
  • Time and Task Management

PHYSICAL DEMANDS
  • This is a standard desk role requiring extended sitting and computer work.

WORK ENVIRONMENT
  • Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.

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