Senior Stop Loss Specialist

Description

The Senior Stop Loss Specialist is responsible for the strategic oversight, financial analysis, and administration of stop-loss (excess loss) programs. This role serves as a subject matter expert and key decision-maker in evaluating high-cost claims, managing vendor relationships, and ensuring optimal financial outcomes related to specific and aggregate stop-loss coverage. This position operates with a high degree of independence and discretion, interpreting contract provisions, advising leadership on financial risk, and driving process improvements that impact organizational performance and cost containment.

 Responsibilities 

  Strategic Claim Oversight & Financial Analysis

• Independently evaluate high-dollar claims against stop-loss contract provisions, determining eligibility, timing, and reimbursement strategy.
• Analyze claim trends, large claimant activity, and reimbursement patterns to identify financial risk and opportunities for cost recovery.
• Exercise discretion in determining submission strategy, escalation needs, and prioritization of claims based on financial impact.

Contract Interpretation & Compliance

• Serve as the internal expert on stop-loss contract terms, including specific and aggregate deductibles, exclusions, and reimbursement provisions.
• Interpret contract language and apply it to complex claim scenarios, making independent determinations that impact reimbursement outcomes.
• Partner with leadership to recommend contract improvements and renewal strategies based on operational and financial insights.

Vendor Management & Negotiation

• Act as the primary liaison with stop-loss carriers and vendors, resolving disputes, negotiating claim determinations, and advocating for reimbursement outcomes.
• Lead discussions with vendors regarding claim eligibility, documentation requirements, and reimbursement discrepancies.
• Evaluate vendor performance and provide recommendations for process improvements and vendor selection decisions.

Process Improvement & Operational Leadership

• Identify gaps in workflows and implement enhancements to improve efficiency, accuracy, and financial outcomes.
• Develop and refine internal procedures for stop-loss tracking, submission, and reporting.
• Provide guidance and mentorship to team members, serving as a resource for complex claim and contract questions.

Reporting, Audit & Organizational Impact

• Lead the preparation and submission of monthly and year-end aggregate filings, ensuring accuracy and completeness.
• Provide detailed reporting and analysis to leadership on stop-loss recoveries, trends, and financial exposure.
• Support internal and external audits by interpreting data, explaining methodologies, and validating financial outcomes.

Requirements

• Bachelor’s degree in Business, Finance, Healthcare Administration, or related field (or equivalent experience)
• 5+ years of experience in stop-loss, claims, or healthcare finance within a TPA, carrier, or self-funded environment
• Demonstrated experience interpreting stop-loss contracts and managing high-dollar claims

Benefits

After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:

• Fantastic medical, dental, and vision insurance*
• Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
• Company provided Basic Life and AD&D
• Company paid Short-Term and Long-Term Disability**
• Flexible Spending Accounts*
• 401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)
• 10+ paid holidays
• Fully Paid half day Summer Fridays
• Generous paid vacation and sick time
• Annual Paid Volunteer Day
• Annual Tuition Reimbursement
• Annual Health and Wellness Reimbursement
• Lots of fun company events

*60 day waiting period

**90 day waiting period  

Who We Are

Cobalt Benefits Group has been named one of the Best Companies to Work for in NH 2026 by NH Business Magazine! As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four lines of business: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue, and Great Bay Administrators. With over 30 years of experience and a dedicated team of more than 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at Cobalt Benefits Group, visit https://www.cobaltbenefitsgroup.com/careers/. 

Cobalt Benefits Group is an Equal Employment Opportunity employer.

Cobalt Benefits Group participates in E-Verify to confirm the employment eligibility of all new hires.