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Canton, Massachusetts, United States
Hybrid
Grow With Us! At Hilb Group, we recognize that our associates are our greatest asset. We promote a service-driven culture of high performance that encourages career and professional development. The Hilb Group is currently seeking a motivated and ambitious Stop Loss Analyst to join our team. This position will report to our agency located in either Cranson, RI, Farmington, CT, Mansfield, MA, Canton, MA, or Southborough, MA. The ideal candidate will be motivated to succeed, is well organized, able to prioritize, and able to work well with a team. This is a hybrid position.
Responsibilities:
Monitor and manage all stop loss reporting activity for assigned clients.
Download and review relevant reports from carrier, TPA, PBM, and stop loss carrier portals.
Analyze, pull, and review medical, pharmacy, eligibility, and stop loss claim data for self-funded clients, including 50% reports, 100% reports, reimbursement notices, pended claims, denied claims, and large claim reporting.
Maintain stop loss tracking databases, reporting logs, and standardized analytics templates to ensure accurate documentation and follow-up.
Coordinate the submission of required documentation and reporting to stop loss carriers within applicable contract timelines.
Follow up persistently on pended or denied claims to ensure claims are adjudicated and reimbursed prior to the end of the stop loss contract period.
Coordinate with stop loss carriers, TPAs, PBMs, and internal consultants regarding reimbursement tracking, outstanding claims, required documentation, and claim resolution.
Ensure prescription drug claim details and reporting are appropriately captured and included in stop loss tracking and reimbursement activity.
Create and maintain standardized HILB client reporting, financial exhibits, and analytics related to stop loss performance and large claims.
Produce monthly, quarterly, and annual stop loss reporting summarizing reimbursement status, pending items, catastrophic claims, and financial exposure.
Manage and maintain monthly claims dashboards for assigned clients.
Review high-cost claimant activity and provide clear month-over-month updates regarding changes in claim costs, diagnoses, treatment activity, prognosis, and potential future exposure, when available.
Validate data received from TPAs, PBMs, carriers, and vendors to ensure accuracy, completeness, and consistency. Identify discrepancies and proactively resolve reporting issues.
Support renewal, marketing, and strategic consulting initiatives by preparing large claim summaries, reimbursement analyses, and stop loss reporting.
Assist with the development and enhancement of internal stop loss monitoring workflows, processes, reporting tools, and quality-control procedures.
Foster a culture of accountability, continuous improvement, and operational excellence.
Contribute to the expansion of advanced claims analytics, including trend analysis, cost drivers, and utilization insights across medical, pharmacy, dental, and ancillary benefits.
Assist in building and maintaining standardized reporting dashboards and executive-level financial exhibits for client renewals and strategic decision-making.
Support employer and employee contribution modeling and other financial analysis related to benefit plan design and renewal decisions.
Partner with internal teams to enhance data integrity, streamline reporting processes, and improve accuracy across RFP, renewal, claims, and contribution datasets.
Contribute to ad hoc analytical projects, including anomaly detection, performance monitoring, and the identification of cost-saving opportunities or coverage gaps.
Qualifications:
Education – High school diploma required; some college level coursework preferred.
Certification – Must obtain and maintain active Life/Accident and Health Insurance Agent License
Experience – Two to five years of experience in employee benefits, stop loss administration, carrier operations, claims analysis, or related field preferred.
Strong analytical and problem-solving skills
Advanced Excel and reporting skills
Excellent organizational and tracking abilities with strong attention to detail
Ability to manage multiple deadlines and prioritize time-sensitive issues
Excellent oral and written communication skills
Strong follow-through and escalation management skills
Experience working with stop loss carriers, TPAs, PBMs, or self-funded plans preferred
Understanding of large claim reporting and reimbursement processes preferred
Proficient in Microsoft Office Suite and Agency Management Systems
Working knowledge and understanding of self-funded and stop loss arrangements
Benefits:
Compensation: $72,000.00/yr.
Company Paid Life Insurance, Long-Term and Short-Term Disability.
Medical, Dental, Vision and FSA/HSA plans.
401(k) with company match.
Additional voluntary benefits including Critical Illness, Accident Insurance, Hospital Indemnity and Supplemental Life Insurance, Legal and Identity Protection, and Pet benefits.
Generous PTO.
An awesome team of professionals!
The Hilb Group is an equal opportunity employer, and we actively support and comply with all applicable federal, state, and local laws prohibiting all forms of discrimination in employment. Additionally, we have a zero-tolerance policy for all forms of harassment in violation of federal, state, and local laws.
