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Work From Home Stop Loss Rn Jobs (NOW HIRING)

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 ...

Work with Senior Stop Loss Consultants and Stop Loss Consultants to ensure complete and accurate RFP submissions.Assist with producing and peer reviewing client deliverables for internal teammates.

Stop Loss Underwriter

Trenton, NJ · On-site +1

$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 ...

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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 Jun 6, 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.
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Stop Loss Underwriting Specialist

Stop Loss Underwriting Specialist

Cambia Health Solutions

Medford, OR • On-site, Remote

$19.40 - $34.90/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 15 days ago


Cambia Health Solutions rating

8.4

Company rating: 8.4 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

102nd of 260 rated insurance


Job description

Stop Loss Underwriting Specialist

Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Stop Loss Underwriting Specialists are living our mission to make health care easier and lives better. The Stop Loss Underwriting Specialist supports the Stop Loss Underwriting team through data entry, running, and reviewing claims reports. This role is responsible for completing contracts and fee schedules and handling all administration of them. Additionally, they complete travel and expenses for stop loss director and team when applicable, and provide other administrative support as directed - all in service of creating an economically sustainable health care system.

Do you thrive as a part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

Stop Loss UW Specialist would have a High School diploma or GED and 4 years office, data entry or equivalent combination of education and experience, preferably in a health care environment. Knowledge of stop loss claims processing preferred.

Skills and Attributes:

  • Demonstrated ability to exercise sound judgment, initiative and discretion in a mature, sensitive and confidential manner.

  • Proven attention to detail and accuracy in data entry and other administrative tasks.

  • Computer skills including experience using Microsoft Office (Word, Excel, Outlook) or comparable software and ability to learn and use complex systems.

  • Ability to organize, prioritize and manage multiple tasks with little supervision.

  • Demonstrated ability to establish effective working relationships with coworkers and customers and to both work well independently and on a team.

  • Ability to communicate effectively both orally and in writing.

  • Knowledge of medical terminology, insurance billing and claims coding.

  • Demonstrated strong problem solving skills and ability to investigate and resolve complex issues.

  • Demonstrated ability to consistently meet productivity and quality standards with minimal support.

  • Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

  • Perform data input for all new stop loss cases and/or claims.

  • Enter all required fields to generate explanation of benefit forms and/or Stop Loss contracts and apply the appropriate fee schedule.

  • Run reports, review and analyze data and identify any areas of concern.

  • Run data downloads and reporting.

  • Review data and prepare management reports.

  • Understand Stop-Loss policy language and terms.

  • May assist with travel and completing expense reports.

The expected hiring range for a Stop Loss Underwriting Specialist is $19.40 - $26.80/hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 6.25%. The current full salary range for this role is $19.40 - $34.90/hour.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

  • Work alongside diverse teams building cutting-edge solutions to transform health care.
  • Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
  • Grow your career with a company committed to helping you succeed.
  • Give back to your community by participating in Cambia-supported outreach programs.
  • Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
  • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.


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