Stop Loss

60 Stop Loss Jobs Hiring Near You

Director, Actuary - Stop Loss Hybrid: 2 days in the office, with Oakbrook Terrace/Chicago preferred. Salary: $145K-$175K + bonus & benefits We are working with a growing, established insurance ...

Brown & Brown is seeking a Trainer Stop Loss Claims to join our growing team! The incumbentis responsible forproviding training for newly hired Specific Stop Loss claims auditors and refresher ...

We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to ...

Stop Loss Underwriter

Stevens Point, WI · On-site +1

$60K - $85K/yr

The Stop Loss Underwriter is responsible for evaluating, pricing, and managing risk for employer-sponsored self-funded health plans. This role includes underwriting both new business and renewals ...

Sr. Underwriter, Stop Loss

Conshohocken, PA · On-site

$96K - $114K/yr

Underwriter, Stop Loss The Sr. Medical Stop-Loss Underwriter is a pivotal team member responsible for managing and underwriting a self-created portfolio of medical stop-loss products. This role ...

We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to ...

Account Manager- Stop Loss

Trenton, NJ · On-site

$50K - $80K/yr

We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to ...

The Sr. Manager of Stop-Loss Operations is responsible for building and leading the stop-loss function that underpins Point C's self-funded health plan business, ensuring accuracy, compliance, and ...

Sr. Underwriter, Stop Loss

Conshohocken, PA

$96K - $114K/yr

Underwriter, Stop Loss The Sr. Medical Stop-Loss Underwriter is a pivotal team member responsible for managing and underwriting a self-created portfolio of medical stop-loss products. This role ...

Showing results 21-40

Stop Loss Jobs Information

Infographic showing various job openings at Stop Loss in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Physical job distribution.

Medical Stop Loss Claims Auditor

EVOLUTION RISK PARTNERS, LLC

Evanston, IL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 14 days ago


Job description

Stop Loss Claims Auditor or Senior Stop Loss Claims Auditor

The Stop Loss Auditor is responsible for auditing and authorizing reimbursements of specific claims and effectively mitigate client medical stop loss claims and provide excellent customer service.

Experience/Qualifications:

  • 3-5+ years of experience in auditing medical Stop Loss Claims.
  • Audit stop loss claims and verify claims are paid in accordance with the Plan Document and reimbursable under the stop loss contract.  
  • Timely follow-up of pending claims to ensure additional information is received.
  • Recognize cost mitigation opportunities.
  • Interpret plan languages and stop loss contracts.
  • Familiar with the process of referring claims for over-authority review and approval to the carrier.
  • Efficient communication with both internal and external customers
  • Experience with auditing aggregate claims
  • Captive experience a plus
  • Ability to analyze claims and/or large claim management reports to post and/or adjust reserves.  

Skills/Abilities

  • 2-3 years medical claim processing or 3-5+ years Stop Loss Claims Auditing and reinsurance experience.
  • Bachelor’s degree a plus.  
  • Experience TPA Claims Processing and cost mitigation.
  • Proficient in Excel (for example: sorting, filtering, data, creating pivot tables.)
  • Ability to interpret and understand Plan Document wording and the application of provisions including eligibility.
  • Knowledge in COB, Medicare rules, CPT codes, REV codes, ICD-10 codes, HCPCS codes, J-codes
  • Excellent customer service, organizational with strong analytical skills
  • Detail/results-oriented
  • Ability to work independently with minimal supervision while meeting or exceeding established production and accuracy standards.
  • Ability to interpret and understand Stop Loss Contracts
  • Customer Service focused.
  • Excellent verbal and written communication skills

 What We Offer:

We're proud to offer a competitive salary, generous and flexible PTO & paid holidays, 401(k) with match, exclusive discount programs, health & wellness programs, and more. 

 Benefits:

  • Health insurance
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible spending account
  • Health savings account
  • Life insurance
  • Vision insurance

About Evolution Risk Partners, LLC

Evolution Risk Partners (ERP) is a full service Managing General Underwriter redefines partnership through a shared vision of success with employers and brokers. We provide organizations with customizable and innovative medical stop-loss solutions to ensure the financial stability of your self-funded medical program. Interested parties should visit www.evolutionrisk.com.