Head of Stop Loss Claims

Job Summary

To build and lead a claims organization, the full-time Head of Stop Loss Claims will develop strategic initiatives, oversee claims operations, and enhance customer experiences in a remote environment.

Key Responsibilities:

• Develop and execute the vision and strategy for the Stop Loss Claims function
• Partner in the design and optimization of claims technology solutions
• Recruit and lead a high-performing claims organization while fostering a culture of continuous improvement

Required Qualifications:

• 10+ years of experience in group insurance claims, particularly with medical stop loss claims operations
• Deep knowledge of stop loss claim adjudication and reimbursement methodologies
• Proven leadership experience in driving operational transformation
• Bachelor's degree in Business, Healthcare Administration, or a related field preferred
• Strong understanding of medical terminology and claims workflows