Stop Loss Operations Analyst

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🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 10%

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Vālenz® Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2004

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Vālenz® Health is a comprehensive health plan solutions provider that offers a fully integrated platform designed to simplify the complexities of healthcare for employers, payers, providers, and members. The company focuses on enhancing quality and lowering costs through data-driven insights, member navigation, provider networks, and robust claims management. By connecting various stakeholders in the healthcare ecosystem, Vālenz aims to improve health outcomes and streamline the healthcare experience for all involved.

📋 Description

• Manage financial and administrative operations supporting the stop loss program • Administer premium receipts, lockbox and ACH activity, and apply premiums to applicable groups and policies • Reconcile enrollment, expected premium, and received premium • Resolve shortages, overpayments, unapplied cash, delinquent premium, and other exceptions • Coordinate return premium, commission and override payments, claim payment activity, and other financial transactions with Finance and Accounts Payable • Perform monthly premium reconciliations and support month-end close, bordereaux, carrier reporting, and program financial reporting • Manage policy administration after final underwriting approval, including sold-case requirements, policy and form selection, preparation, amendments, endorsements, and outstanding-item tracking • Review policy materials against approved underwriting terms and escalate discrepancies before issuance • Coordinate policy issuance activities performed by Stop Loss Specialists • Maintain procedures, quality controls, status reporting, reconciliations, exception reporting, controls, and audit evidence • Administer agency and producer licensing, carrier appointments, renewals, state-specific requirements, regulatory correspondence, and related documentation • Maintain TPA and producer due diligence documentation and support approval processes • Support carrier, financial, and internal audits and resolve identified exceptions • Develop operational reporting and identify opportunities to improve accuracy, efficiency, transparency, controls, and cross-training • Coordinate workflows across Stop Loss Specialists and internal partners • Escalate material underwriting, financial, contractual, or compliance matters to leadership • Recommend process, control, and system improvements • Perform other duties as assigned

🎯 Requirements

• 3+ years of experience in insurance operations, premium administration, accounting or reconciliation, policy administration, or a related field • Working knowledge of self-funded medical plans, employer stop loss terminology, insurance contracts, and operational workflows • Strong reconciliation and analytical skills across premium, enrollment, policy, and financial data • Ability to interpret policy and underwriting terms and identify discrepancies requiring review • Experience managing financial or administrative processes with defined controls, deadlines, and documentation requirements • Strong attention to detail and ability to maintain accurate, complete, audit-ready records • Strong organizational and time-management skills • Effective written and verbal communication skills and ability to collaborate with carriers, TPAs, producers, Finance, Underwriting, Claims, and internal partners • Proficiency with Microsoft Office, including Excel and Word • Ability to learn stop loss administration, underwriting, and reporting platforms • Ability to independently manage assigned operational processes and escalate material exceptions appropriately • Must be US based and work in compliance with company policies such as HIPAA • Reliable internet connection • Ability to adhere to security protocols, including VPNs, secure passwords, and company-approved devices/software • Bachelor's degree in Accounting, Finance, Business, Insurance, or a related field is a plus • Experience with employer stop loss, self-funded medical plans, premium administration, or policy issuance is a plus • Experience with carrier bordereaux, month-end reconciliation, insurance financial reporting, licensing, carrier appointments, producer records, policy preparation, endorsements, amendments, due diligence, audits, or relevant platforms is a plus

🏖️ Benefits

• Generous compensation commensurate with experience and performance • Competitive benefits package with generous employer subsidies • Flexible and remote working options • 401k with generous employer match and immediate vesting • Personal and professional development opportunities • Supportive family benefits, including paid leave for new family members • Companywide philanthropic program, Valenz Communities Connection • Necessary equipment provided • Medical, Dental, and Vision insurance • HSA, FSA, and DCFSA spending account options • Flexible working environment • Generous Paid Time Off, including vacation, sick leave, and paid holidays • Employee Assistance Program with professional counseling, referrals, and additional services • Paid maternity and paternity leave • Pet insurance • Employee discounts on phone plans, car rentals and computers • Community giveback opportunities, including paid time off for philanthropic endeavors

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