Stop Loss Operations Specialist

🔥 13 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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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, including premium administration, policy issuance, licensing, reconciliation, and operational controls • Ensure transactions, policy documentation, and regulatory records are accurate, timely, and audit-ready • Collaborate with Underwriting, Claims, Finance, TPAs, producers, carriers, and Stop Loss leadership to resolve exceptions and improve processes • Administer premium receipts, lockbox and ACH activity, and apply premiums to groups and policies in stop loss systems • 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 other 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 and maintain procedures, quality controls, and status reporting • 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 • Develop and maintain operational procedures, reconciliations, exception reporting, controls, and audit evidence • Support carrier, financial, and internal audits and coordinate resolution of 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 • Recommend process, control, and system improvements to Stop Loss leadership and functional partners • 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 • Experience managing financial or administrative processes with defined controls, deadlines, and documentation requirements • Strong attention to detail and ability to maintain accurate, complete, and audit-ready records • Strong organizational and time-management skills • Effective written and verbal communication skills • 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 • US-based, in a location where the employee can work effectively and comply with company policies such as HIPAA • Reliable internet connection • Quiet workspace free from distractions • Adherence to company security protocols, including VPNs, secure passwords, and company-approved devices/software • Bachelor's degree in Accounting, Finance, Business, Insurance, or a related field (a plus) • Experience with employer stop loss, self-funded medical plans, premium administration, or policy issuance (a plus) • Experience with carrier bordereaux, month-end reconciliation, or insurance financial reporting (a plus) • Experience administering insurance licensing, carrier appointments, producer records, or related regulatory requirements (a plus) • Experience supporting policy preparation, endorsements, amendments, or quality review of insurance documents (a plus) • Experience with TPA or producer due diligence and approval processes (a plus) • Experience supporting carrier, financial, compliance, or operational audits (a plus) • Experience with stop loss administration, underwriting, policy, or reporting platforms (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 • Fully remote position with necessary equipment provided • Generously subsidized company-sponsored 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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