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Work From Home Stop Loss Rn Jobs in Georgia (NOW HIRING)

The Jernigan Agency

WORK FROM HOME

Decatur, GA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Blythe, GA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Box Springs, GA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

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Work From Home Stop Loss Rn information

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.
What are popular job titles related to Work From Home Stop Loss Rn jobs in Georgia? For Work From Home Stop Loss Rn jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Work From Home Stop Loss Rn jobs in Georgia look for? The top searched job categories for Work From Home Stop Loss Rn jobs in Georgia are:
What cities in Georgia are hiring for Work From Home Stop Loss Rn jobs? Cities in Georgia with the most Work From Home Stop Loss Rn job openings:
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Infographic showing various Work From Home Stop Loss Rn job openings in Georgia as of July 2026, with employment types broken down into 70% Full Time, 21% Part Time, and 9% Contract. Highlights an 100% Remote job distribution.

Director of Clinical & Cost Containment, Employee Benefits

HUB International Limited

Atlanta, GA • On-site, Remote

$76K - $104K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

HUB International rating

8.0

Company rating: 8.0 out of 10

Based on 140 frontline employees who took The Breakroom Quiz

161st of 300 rated insurance

Job description

Position Summary
The Director of Clinical & Cost Containment is a senior strategic role within Strategic Benefit Resources (SBR) responsible for leading the clinical consulting and cost containment program capabilities that differentiate SBR's self-funded solutions in the wholesale distribution market. This individual serves as the primary clinical subject matter expert across SBR's book of business, partnering with sales, distribution, and stop-loss consulting teams to evaluate, implement, and communicate clinical cost containment strategies that drive measurable financial outcomes for employer clients.
This role bridges clinical expertise and consultative sales support - working directly with broker/consultant partners, TPAs, stop-loss carriers, and employer plan sponsors to identify high-cost claim drivers, optimize vendor program selection, and develop clinical frameworks that reduce plan cost and improve member outcomes.
Why This Role Exists
As the self-funded benefits market grows increasingly complex - driven by specialty drug spend, catastrophic claim frequency, and heightened employer demand for transparency - SBR's distribution model requires dedicated clinical leadership to:
  • Evaluate and validate cost containment vendor solutions (Rx carve-outs, case management, utilization review, reference-based pricing, direct contracting) presented to clients
  • Provide clinical oversight and credibility in stop-loss consulting engagements
  • Identify coverage gap risks (e.g., Rx carved out of medical stop-loss) and proactively protect clients and SBR's risk profile
  • Position SBR as a value-added clinical advisory resource to differentiate from transactional wholesale competitors

Key Responsibilities
Clinical Cost Containment Strategy
  • Lead the development and ongoing refinement of SBR's clinical cost containment framework, aligning strategies with market trends and client needs
  • Evaluate, vet, and recommend cost containment vendors and programs (utilization management, case management, pharmacy benefit management, transplant networks, reference-based pricing, direct primary care, etc.)
  • Analyze claims data, clinical utilization trends, and high-cost claimant profiles to identify actionable savings opportunities
  • Monitor medical cost trends, specialty drug pipelines, and catastrophic claim drivers to proactively advise clients and sales teams

Stop-Loss Carrier Support / Claims Support
  • Review TPA trigger reports and claim referrals to surface impending high-cost diagnoses and recommend clinical risk mitigation actions
  • Identify and communicate coverage gap risks when Rx is carved out of stop-loss contracts or when benefit plan design creates clinical exposure
  • Serve as clinical liaison between SBR, stop-loss carriers, TPAs, and employer plan sponsors on complex claims and risk management issues

Consulting & Distribution Enablement
  • Support SBR's sales and consulting teams with clinical presentations, client-facing materials, and technical talking points for broker/consultant audiences
  • Conduct clinical reviews and plan analyses for prospective and existing employer clients, translating clinical findings into financial impact narratives
  • Develop educational resources, webinars, and market-facing content that position SBR's clinical expertise as a competitive differentiator
  • Partner with distribution leadership and brokers/consultants to align cost containment program recommendations with individual client risk profiles and plan designs

Vendor Management & Program Oversight
  • Build and maintain relationships with clinical cost containment vendors, including case management firms, utilization review organizations, PBMs, and specialty program providers
  • Evaluate vendor performance through KPI monitoring, outcome tracking, and savings validation
  • Negotiate program terms and coordinate seamless integration of clinical vendors within the SBR distribution ecosystem
  • Stay current on regulatory developments, ERISA compliance requirements, and clinical best practices affecting self-funded plan design

Internal Leadership & Collaboration
  • Partner with the Chief Strategy Officer, COO, and sales leadership to align clinical strategy with SBR's overall growth objectives
  • Provide clinical training and education to internal SBR teams, ensuring consultants can confidently represent cost containment solutions
  • Contribute to the development of SBR's strategic plan as it relates to clinical program expansion, new vendor partnerships, and market positioning

Qualifications
Required
  • Bachelor's degree in Nursing, Healthcare Administration, Health Sciences, or a related clinical field; RN license strongly preferred
  • 5+ years of experience in clinical cost containment, case management, utilization management, stop-loss, or self-funded health plan consulting
  • Deep knowledge of self-funded employer benefit plan design, stop-loss insurance structures, and the TPA/wholesale distribution market
  • Demonstrated understanding of medical coding (ICD-10, CPT), clinical guidelines, and claims adjudication processes
  • Experience working with or evaluating cost containment vendors including case management, PBMs, reference-based pricing, and specialty drug management programs
  • Strong analytical and data interpretation skills; ability to translate clinical findings into financial and strategic insights
  • Excellent communication, presentation, and relationship management skills with broker, consultant, and employer-level audiences

Preferred
  • Certification in Case Management (CCM), Certified Employee Benefit Specialist (CEBS), or equivalent professional credential
  • Experience with pharmacy carve-out structures and Rx cost containment programs in the self-funded context (e.g., PMPM guarantee models, closed formulary programs)
  • Familiarity with all types of self funded arrangements including captive insurance structures, level-funded plans, or consortium-based stop-loss arrangements
  • Prior experience in a wholesale benefits distribution, MGU, or TPA environment
  • Working knowledge of ERISA, HIPAA, ACA implications for self-funded plan sponsors

Core Competencies
  • Clinical Expertise & Credibility - Trusted subject matter authority on medical management and cost containment within the self-funded market
  • Strategic Thinking - Connects clinical insights to business outcomes and competitive positioning
  • Consultative Communication - Translates complex clinical concepts for non-clinical stakeholders including brokers, employers, and executives
  • Analytical Rigor - Data-driven approach to evaluating program performance and identifying savings opportunities
  • Relationship Building - Skilled at developing trusted partnerships with vendors, TPAs, carriers, and distribution partners
  • Market Awareness - Proactive in monitoring industry trends, emerging cost drivers, and regulatory changes

Compensation & Benefits
SBR offers a competitive compensation package commensurate with experience, including:
  • Base salary commensurate with experience
  • Performance-based incentive compensation
  • Comprehensive health, dental, and vision benefits
  • Retirement plan with employer contribution
  • Professional development and continuing education support
  • Hybrid/remote work flexibility

The expected salary range for this position is $130,000 to $150,000 and will be impacted by factors such as the successful candidate's skills, experience and working location, as well as the specific position's business line, scope and level. HUB International is proud to offer comprehensive benefit and total compensation packages which could include health/dental/vision/life/disability insurance, FSA, HAS and 401(k) accounts, paid-time-off benefits such as vacation, sick, personal, floating holidays and company holidays. In addition, eligible annual bonuses, equity and commissions may be available for some positions.
#SPG
Department Business Operations
Required Experience: 5-7 years of relevant experience
Required Travel: Up to 25%
Required Education: Bachelor's degree (4-year degree)
HUB International Limited is an equal opportunity employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations.
E-Verify Program
We endeavor to make this website accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the recruiting team HUBRecruiting@hubinternational.com. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications.

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