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Work From Home Stop Loss Rn Jobs (NOW HIRING)

Tribeca Pediatrics

Registered Nurse (WFH/Hybrid)

$40/hr

The Registered Nurse will primarily communicate with patients through phone triage to assess and ... Ability to work independently, as well as effectively with others * Excellent time management ...

New

Symetra

Senior Stop Loss Underwriter - Remote

$87K - $146K/yr

Our programs are designed to make your life better both at work and at home. * Flexible full-time ... Disqualification from the recruitment process * Withdrawal of a job offer * Termination of ...

Novacore

Medical Review Nurse

Conshohocken, PA · Remote

From day one, you'll find mentorship, hands-on learning and clear paths for advancement. You'll ... Medical Review Nurse Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in ...

J3 Owens Group

Work From Home - For Real

Charleston, SC · On-site +1

Stop pretending to "work from home." Build a real business with real income. Join a proven system that offers mentorship, training, and high-earning potential. Faith. Freedom. Financial Growth. 1099 ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

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All JobsStop Loss Rn JobsWork From Home Stop Loss Rn Jobs

Work From Home Stop Loss Rn information

See salary details

$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:
What states have the most Work From Home Stop Loss Rn jobs? States with the most job openings for Work From Home Stop Loss Rn jobs include:
What job categories do people searching Work From Home Stop Loss Rn jobs look for? The top searched job categories for Work From Home Stop Loss Rn jobs are:
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.
Medical Stop Loss Claims Group Insurance (Remote)

Medical Stop Loss Claims Group Insurance (Remote)

Prudential Financial, Inc.

Newark, NJ • On-site, Remote

$106K - $174K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Prudential rating

8.7

Company rating: 8.7 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

66th of 281 rated insurance

Job description

Job Classification:
Operations - Insurance Operations
Help Lead the Future of Medical Stop Loss Claims at Prudential
Prudential is continuing to grow and expand its capabilities as a premier medical stop loss carrier. As part of this exciting evolution, we are seeking a Head of Stop Loss Claims to build and lead our claims organization.
This is a unique opportunity for a hands-on leader who thrives in high-growth environments and is energized by creating processes, developing talent, and shaping the future of a business. You'll play a critical role in designing our claims operations, driving innovation, and ensuring an exceptional experience for our customers, brokers, consultants, and partners.
Key Responsibilities:
Strategic Leadership
  • Develop and execute the vision, strategy, and operating model for Prudential's Stop Loss Claims function.
  • Establish scalable workflows, governance, and best practices that support continued growth and operational excellence.

Claims System Development
  • Partner in the design, implementation, and optimization of claims technology solutions.
  • Provide subject matter expertise to ensure efficient workflows and industry-leading claims practices.

Team Building & Leadership
  • Recruit, develop, and lead a high-performing claims organization.
  • Foster a culture of accountability, collaboration, continuous improvement, and professional development.

Claims Oversight
  • Review and approve high-dollar and complex medical stop loss claims.
  • Ensure consistent, accurate claim adjudication aligned with policy provisions, contractual obligations, and company standards.

Stakeholder Management
  • Serve as the primary claims leader and ambassador for Prudential's Medical Stop Loss business.
  • Build strong relationships with brokers, TPAs, reinsurers, vendors, consultants, and internal partners.

Operational Excellence & Innovation
  • Leverage data, analytics, and technology to improve accuracy, efficiency, and service delivery.
  • Drive process improvements that reduce cycle times and enhance the customer experience.

Regulatory Compliance
  • Ensure adherence to all applicable federal and state regulations, contractual requirements, and internal controls.

Cross-Functional Partnership
  • Collaborate across underwriting, implementation, account management, finance, actuarial, and operations teams to deliver seamless end-to-end service.

Qualifications:
Required Experience
  • 10+ years of experience in group insurance claims including some meaningful experience supporting medical stop loss claims operations.
  • Deep knowledge of stop loss claim adjudication, reimbursement methodologies, policy interpretation, and industry best practices.
  • Proven experience leading teams and driving operational transformation in a growing organization.

Technical Expertise
  • Strong understanding of medical terminology, CPT/HCPCS/ICD-10 coding, stop loss policy language, and claims workflows.
  • Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, and Outlook.

Leadership Characteristics
  • Builder mindset with the ability to create structure in a growing business.
  • Strong executive presence, communication skills, and stakeholder management capabilities.
  • Demonstrated success leading through change, influencing across functions, and developing talent.

Education
  • Bachelor's degree in Business, Healthcare Administration, or a related field preferred.

What we offer you:
Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $106,000.00 to $174,900.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills.
  • Market competitive base salaries, with a yearly bonus potential at every level.
  • Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave.
  • 401(k) plan with company match (up to 4%).
  • Company-funded pension plan.
  • Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.
  • Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
  • Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.
  • Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period).

Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week.
Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom.
Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law.
If you need an accommodation to complete the application process, please email accommodations.hw@prudential.com.
If you are experiencing a technical issue with your application or an assessment, please email careers.technicalsupport@prudential.com to request assistance.

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