Summary The Manager of Stop Loss for Lucent oversees all aspects of stop loss claim administration, ensuring accurate, timely, and compliant handling of both specific and aggregate claims. This leadership role requires strategic management of internal staff, coordination with carriers, clients, and brokers, and the continuous development and optimization of stop loss processes to mitigate financial risk for self-funded health plans.
Responsibilities - Team Leadership & Oversight
- Supervise and mentor the stop loss claims team, providing guidance on complex cases and workflow management.
- Conduct performance evaluations, identify training needs, and foster professional development.
- Implement best practices for auditing, quality assurance, and operational efficiency within the team.
- Stop Loss Administration
- Oversee the preparation, submission, and follow-up of specific and aggregate stop loss claims to ensure timely reimbursement from carriers
- Review high-dollar claims, coordinate advance funding, and monitor group and plan year-end claims activity.
- Ensure compliance with stop loss policy contracts, regulatory guidelines, and internal SOPs.
- Client & Broker Engagement
- Serve as primary point of contact for clients and brokers regarding stop loss claim inquiries, renewals, contract interpretations, and resolution of escalated issues.
- Provide strategic risk analysis and reporting to support client decision-making and contractual obligations.
- Process Improvement & Compliance
- Analyze team workflows and identify opportunities for process enhancements, automation, and efficiency gains.
- Maintain accurate records, dashboards, and reporting of stop loss activity for leadership and carrier review.
- Ensure adherence to HIPAA, ERISA, and applicable state and federal regulatory standards.
- Cross-Functional Collaboration
- Work closely with finance, claims and client services to verify attachment points, contract alignment, and funding requirements.
- Coordinate with internal departments to ensure seamless plan administration and claim resolution.
- Risk Management & Oversight
- Monitor aggregate claim levels, policy limits, and excess exposure across the book of business.
- Identify trends in stop loss claims to support predictive risk modeling and cost-containment strategies.
Qualifications - Education: Bachelor's degree in business, healthcare administration, insurance, finance, or related field preferred. Equivalent experience considered.
- Experience:
- Minimum of 5-7 years of experience in self-funded healthcare, stop loss administration, or claims management.
- Prior management or team lead experience in a TPA or insurance carrier environment is required.
- Hands-on knowledge of specific and aggregate stop loss plans and administration.
- Skills & Competencies:
- Strong leadership, communication, and interpersonal skills.
- Proficiency in Microsoft Office Suite, including Excel for reporting and analysis.
- High attention to detail with strong analytical and organizational capabilities.
- Ability to manage multiple priorities under strict deadlines.
- Knowledge of regulatory compliance, underwriting principles, and TPA operations.
Preferred- Experience implementing process improvements and quality control initiatives.
- Familiarity with stop loss software platforms and claims management systems.
- Strong client relationship management skills and ability to act as a subject matter expert.
