Stop Loss Operations Specialist

Accountabilities:

Manage the financial and administrative operations of the stop loss program, including premium administration, policy issuance, licensing, reconciliations, and operational controls.
Process premium receipts, lockbox transactions, and ACH payments, ensuring accurate allocation of premiums to the appropriate employer groups and insurance policies.
Reconcile enrollment records, expected premiums, and received payments, investigating and resolving shortages, overpayments, unapplied cash, delinquent premiums, and other financial discrepancies.
Coordinate return premium transactions, commissions, override payments, claim payments, and other financial activities in collaboration with Finance and Accounts Payable teams.
Maintain accurate supporting documentation and reconciliation records for all financial transactions.
Perform monthly premium reconciliations and support month-end closing activities, carrier bordereaux, financial reporting, and other program-related reports.
Manage policy administration following final underwriting approval, including sold-case requirements, policy and form selection, document preparation, amendments, endorsements, and outstanding-item tracking.
Review policy documentation against approved underwriting terms, verifying deductibles, aggregate provisions, contract basis, lasers, exclusions, effective dates, terminal liability provisions, and special endorsements.
Identify and escalate discrepancies in policy terms or documentation before issuance to ensure contractual accuracy.
Coordinate policy issuance activities across Stop Loss Specialists while maintaining documented procedures, quality assurance standards, and status reporting.
Administer agency and producer licensing, carrier appointments, renewals, state-specific requirements, regulatory correspondence, and related documentation.
Maintain due diligence records for third-party administrators and producers while supporting applicable approval and compliance processes.
Develop and maintain operational procedures, reconciliation processes, exception reports, internal controls, and audit documentation covering premium, policy, and licensing activities.
Support internal, financial, and carrier audits, ensuring that identified discrepancies and exceptions are documented and resolved promptly.
Prepare operational reports, monitor performance, and identify opportunities to improve accuracy, efficiency, transparency, and internal controls.
Coordinate workflows across Stop Loss Specialists and internal stakeholders, escalating significant underwriting, financial, contractual, or compliance matters to the appropriate leadership.
Recommend improvements to operational processes, systems, and controls in collaboration with Stop Loss leadership and relevant departments.
Perform additional responsibilities as assigned and comply with applicable workplace, data security, and regulatory requirements.
Requirements:
At least 3 years of professional experience in insurance operations, premium administration, accounting, financial reconciliation, policy administration, or a related field.
Working knowledge of self-funded medical plans, employer stop loss insurance terminology, insurance contracts, and related operational processes.
Strong analytical and reconciliation skills, with the ability to accurately manage and interpret premium, enrollment, policy, and financial data.
Demonstrated ability to understand insurance policy provisions and underwriting terms, identify discrepancies, and determine when additional review or escalation is necessary.
Experience managing financial or administrative processes involving established controls, documentation standards, and recurring deadlines.
Exceptional attention to detail and a commitment to maintaining accurate, complete, and audit-ready records.
Strong organizational and time-management abilities, with the capacity to manage multiple workflows and competing priorities.
Excellent written and verbal communication skills, with the ability to collaborate effectively with insurance carriers, TPAs, producers, and internal teams across Finance, Underwriting, and Claims.
Proficiency in Microsoft Office applications, particularly Excel and Word, with the ability to learn specialized insurance administration, underwriting, and reporting platforms.
Ability to independently manage assigned operational responsibilities while following established procedures and escalating significant issues appropriately.
Strong problem-solving skills, sound judgment, and a proactive approach to identifying operational risks and process improvements.
Ability to work effectively in a fully remote environment, maintain a quiet and secure workspace, and meet company technology and information security requirements.
Reliable internet connectivity and willingness to comply with security protocols, including VPN usage, secure passwords, and approved devices and software.
Must be based in the United States and able to comply with applicable data privacy and healthcare regulations, including HIPAA.
The following qualifications and experience are considered an advantage:
Bachelor's degree in Accounting, Finance, Business Administration, Insurance, or a related discipline.
Previous experience in employer stop loss insurance, self-funded healthcare plans, premium administration, or insurance policy issuance.
Familiarity with carrier bordereaux, monthly financial reconciliations, and insurance reporting processes.
Experience managing insurance licensing, carrier appointments, producer records, renewals, and regulatory documentation.
Previous involvement in policy preparation, endorsements, amendments, and quality reviews of insurance documentation.
Experience with TPA or producer due diligence, onboarding, and approval procedures.
Experience supporting carrier, financial, compliance, or operational audits.
Familiarity with stop loss administration, underwriting, policy management, or insurance reporting platforms.
Benefits:
Fully remote position: Work from anywhere within the United States, with the necessary equipment provided.
Medical coverage: Generously subsidized company-sponsored medical insurance.
Dental and vision insurance, with access to additional healthcare services through specialized company healthcare solutions.
Flexible spending account options, including Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Dependent Care Flexible Spending Accounts (DCFSA).
401(k) retirement savings plan with employer matching contributions and immediate vesting.
Flexible working environment designed to support work-life balance.
Generous paid time off, including vacation days, sick leave, and paid company holidays.
Employee Assistance Program offering professional counseling, referrals, and additional support services.
Paid maternity and paternity leave.
Pet insurance options.
Employee discounts on phone plans, car rentals, and computers.
Community engagement and philanthropic opportunities, including paid time off for volunteer activities.
Inclusive and collaborative workplace culture built around the values of collaboration, performance, transparency, and trust.
Opportunities to contribute to meaningful initiatives that improve healthcare affordability, quality, accessibility, and efficiency.