Medical Stop Loss Claims – Group Insurance

🕒 Julho 2

🏖️ New Jersey – Remoto

🏖️ New Jersey – Remote

💵 $106.000 - $174.900 / ano

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

🔒 Seguros

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Prudential Financial

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1875

💸 Finanças

🛡️ Seguros

🏠 Imobiliário

Finance • Insurance • Real Estate

A Prudential Financial é uma líder multinacional em serviços financeiros, com operações nos Estados Unidos, Ásia, Europa e América Latina. Com uma tradição em seguros de vida e gestão de ativos, a empresa ajuda clientes individuais e institucionais a crescer e proteger seu patrimônio. A Prudential oferece uma variedade de produtos e serviços, incluindo seguros de vida, anuidades, serviços relacionados à aposentadoria, fundos de investimento, gestão de ativos e serviços imobiliários.

Descrição

• 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 • Partner in the design, implementation, and optimization of claims technology solutions • Provide subject matter expertise to ensure efficient workflows and industry-leading claims practices • Recruit, develop, and lead a high-performing claims organization • Foster a culture of accountability, collaboration, continuous improvement, and professional development • 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 • 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 • Leverage data, analytics, and technology to improve accuracy, efficiency, and service delivery • Drive process improvements that reduce cycle times and enhance the customer experience • Ensure adherence to all applicable federal and state regulations, contractual requirements, and internal controls • Collaborate across underwriting, implementation, account management, finance, actuarial, and operations teams to deliver seamless end-to-end service

🎯 Requisitos

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

🏖️ Benefícios

• Medical, dental, vision, life insurance, disability insurance • Paid Time Off (PTO) • 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)