Stop Loss Claims Director
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Director of Stop Loss Claims will be responsible for the leadership and oversight of all Stop Loss claim operations. This position ensures timely, accurate, and compliant adjudication of claims and plays a vital role in supporting risk management, client satisfaction, and financial performance. Reporting directly to the Vice President of Operations, the Director leadsa team dedicated solely to Stop Loss claims and collaborates cross-functionally to drive performance and operational excellence.

Principal Duties and Responsibilities:

• Lead and manage the Stop Loss claims unit, ensuring productivity, compliance, and service standards are consistently met.
• Oversee all aspects of the Stop Loss claims lifecycle from intake to resolution, ensuring proper documentation, review, and timely processing.
• Serve as the primary claims liaison to internal stakeholders such as underwriting, actuarial, legal, finance, and policy administration teams.
• Maintain claims inventory to ensure clean claims are resolved within 10 business days or less.
• Establish and monitor reserves on Stop Loss claims to ensure financial accuracy and appropriate liability recognition.
• Analyze claim trends to identify risk patterns and provide actionable feedback to underwriting and leadership teams.
• Develop and maintain relationships with third-party administrators, vendors, and key clients to ensure claims alignment and performance.
• Support regulatory, compliance, and audit requirements by maintaining proper controls and documentation.
• Lead regular team meetings, performance reviews, and professional development planning for direct reports.
• Identify and implement process improvements and system enhancements to increase efficiency and accuracy.

Required:

• Bachelor's degree required; advanced degree or relevant certifications (e.g., CEBS, ARM) a plus.
• 5-7 years of experience in Stop Loss claims management, with a minimum of 3 years in a supervisory or leadership capacity.
• Deep understanding of Stop Loss products, reinsurance, and claim adjudication best practices.
• Strong leadership and team management skills.
• Excellent communication and decision-making ability.
• Financial and analytical acumen with a focus on claims reserving and budgeting.
• Technologically savvy with experience in claims management systems and reporting tools.

Seniority level

• Seniority levelDirector

Employment type

• Employment typeFull-time

Job function

• Job functionAccounting/Auditing
• IndustriesInsurance, Insurance Agencies and Brokerages, and Insurance and Employee Benefit Funds

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Pension plan

Disability insurance

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