Prudential Financial

Medical Stop Loss Claims Group Insurance (Remote)

Prudential Financial • $106K — $174K *
US-Anywhere
+ 52 other locationsRemote
Healthcare
8 - 10 years of experience
2 weeks ago
Job Overview by Ladders

Qualifications

  • 10+ years of experience in group insurance claims with a focus on medical stop loss claims.
  • In-depth knowledge of stop loss claim adjudication, reimbursement practices, and policy interpretation.
  • Demonstrated leadership experience in operational transformation within a growing organization.
  • Strong understanding of medical terminology, and relevant coding systems (CPT/HCPCS/ICD-10).
  • Proficient in Microsoft Office suite, especially Excel and PowerPoint.
  • Effective communication, executive presence, and stakeholder management skills.
  • Ability to foster growth and structure in a dynamic business environment.

Responsibilities

  • Develop and execute the vision and strategy for the Stop Loss Claims function.
  • Establish scalable workflows and best practices to enhance operational excellence.
  • Design and optimize claims technology solutions and ensure efficiency.
  • Lead a high-performing claims team focused on accountability and improvement.
  • Review and approve complex medical stop loss claims for accuracy.
  • Build relationships with brokers, TPAs, and internal stakeholders to strengthen business operations.
  • Utilize data analytics to drive process improvements and enhance service delivery.
  • Ensure compliance with applicable regulations and internal controls.

Benefits

  • Market competitive base salaries with yearly bonus potential.
  • Comprehensive medical, dental, and vision insurance, along with life and disability insurance.
  • Generous Paid Time Off (PTO) and leave policies including parental leave.
  • 401(k) plan with company match and a company-funded pension.
  • Wellness reimbursement program up to $1,600 per year for personal wellbeing.
  • Work/Life Resources to support various personal and professional needs.
  • Education benefits for traditional college courses and accredited programs.
  • Employee Stock Purchase Plan allowing employees to buy company shares at a discount.
Full Job Description
Job Classification:
Operations - Insurance Operations

Key Responsibilities:

Strategic Leadership
  • Develop and execute the vision, strategy, and operating model for Prudential's Stop Loss Claims function.
  • Establish scalable workflows, governance, and best practices that support continued growth and operational excellence.

Claims System Development
  • Partner in the design, implementation, and optimization of claims technology solutions.
  • Provide subject matter expertise to ensure efficient workflows and industry-leading claims practices.


Team Building & Leadership
  • Recruit, develop, and lead a high-performing claims organization.
  • Foster a culture of accountability, collaboration, continuous improvement, and professional development.


Claims Oversight
  • Review and approve high-dollar and complex medical stop loss claims.
  • Ensure consistent, accurate claim adjudication aligned with policy provisions, contractual obligations, and company standards.


Stakeholder Management
  • Serve as the primary claims leader and ambassador for Prudential's Medical Stop Loss business.
  • Build strong relationships with brokers, TPAs, reinsurers, vendors, consultants, and internal partners.


Operational Excellence & Innovation
  • Leverage data, analytics, and technology to improve accuracy, efficiency, and service delivery.
  • Drive process improvements that reduce cycle times and enhance the customer experience.


Regulatory Compliance
  • Ensure adherence to all applicable federal and state regulations, contractual requirements, and internal controls.


Cross-Functional Partnership
  • Collaborate across underwriting, implementation, account management, finance, actuarial, and operations teams to deliver seamless end-to-end service.


Qualifications:

Required Experience
  • 10+ years of experience in group insurance claims including some meaningful experience supporting medical stop loss claims operations.
  • Deep knowledge of stop loss claim adjudication, reimbursement methodologies, policy interpretation, and industry best practices.
  • Proven experience leading teams and driving operational transformation in a growing organization.


Technical Expertise
  • Strong understanding of medical terminology, CPT/HCPCS/ICD-10 coding, stop loss policy language, and claims workflows.
  • Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, and Outlook.


Leadership Characteristics
  • Builder mindset with the ability to create structure in a growing business.
  • Strong executive presence, communication skills, and stakeholder management capabilities.
  • Demonstrated success leading through change, influencing across functions, and developing talent.


Education
  • Bachelor's degree in Business, Healthcare Administration, or a related field preferred.


What we offer you:

Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $106,000.00 to $174,900.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills.
  • Market competitive base salaries, with a yearly bonus potential at every level.
  • Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave.
  • 401(k) plan with company match (up to 4%).
  • Company-funded pension plan.
  • Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.
  • Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
  • Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.
  • Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period).


Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week.

Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom.



If you are experiencing a technical issue with your application or an assessment, please email [email protected] to request assistance.

About Prudential Financial

Prudential Financial is a financial services company that specializes in the fields of investment management, life insurance, and retirement benefits. It focuses on helping individuals and institutional customers to grow and protect their wealth. The company also offers an inclusive work environment where employees can develop to their full potential, and give back to the communities where they live and work. Prudential Financial was founded in 1875 and headquartered in Newark, New Jersey.

Prudential Financial Careers

Join the esteemed ranks of Prudential Financial, a global leader in financial services, where your career is nurtured, your innovation valued, and your professional growth guaranteed. Work You’ll Do At Prudential Financial, we are committed to helping individuals and businesses tackle their financial challenges with robust solutions. As part of our team, you will lead efforts to innovate and expand our services, ensuring that we remain at the forefront of the financial industry. Transform the financial landscape with your expertise and join a team where diversity, leadership, and personal growth are not just encouraged but actively fostered. With Prudential Financial, you position yourself at the nexus of finance and cutting-edge innovation. Collaborate with a global network of professionals, dedicated to steering clients through their financial journeys with precision and foresight. Our culture thrives on teamwork, leadership, and a shared commitment to excellence. Prudential Financial Job Opportunities We are actively hiring and have a variety of job opportunities designed to bring out the best in each employee. From entry-level positions to leadership roles, Prudential Financial offers a path for every ambitious professional eager to make an impact in the financial sector. Do Innovative Work Join our team of over 40,000 professionals worldwide, working together to reshape the future of finance. At Prudential Financial, your skills in networking, strategic thinking, and leadership will drive change and foster an environment of continuous innovation and growth. Internship Programs Kickstart your career with a Prudential Financial internship. Our programs offer invaluable industry insights and hands-on experience, making them a perfect starting point for students and recent graduates eager to make their mark. Benefits and Culture Prudential Financial is not just about professional achievements but also about personal well-being. Our employees enjoy comprehensive benefits, including health, life, and disability insurance, retirement plans, and generous paid time off. More than just benefits, our company culture is built on mutual respect, inclusivity, and the collective pursuit of excellence. Future-Proof Your Career With Prudential Financial, career advancement is a reality. We provide extensive training and development programs, including leadership and diversity training, to ensure you are always ahead of the curve. Explore Discover how Prudential Financial leads the way in financial innovation and client service. Read more about our latest projects and the impact they have on our clients and the industry. Stay Connected Join Our Team Search open positions that match your skills and interests. We are looking for passionate, curious, and solution-driven team players. Explore Prudential Financial jobs today and find where you fit in our dynamic team. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can put to use today—all from the people who work here. Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await at Prudential Financial.
Learn more about Prudential Financial
Size
88 employees
Market Cap
$36.2 billion
Industry
Finance & Insurance
Net Income
-$374 million
Founded
1875
5 Year Trend
+3.8%
Revenue
$57 billion
NASDAQ
PBIP
* Ladders Estimates

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