Senior Stop Loss Consultant

Senior Stop Loss Consultant

The Senior Stop Loss Consultant is a foundational member of our stop-loss consulting practice, responsible for leading day-to-day execution while contributing to the broader development of our team structure, workflows, and market positioning. This role combines individual execution and informal leadership responsibilities including placement strategy, client consulting, team workflow oversight, and reimbursement resolution.

The ideal candidate is a strong operator and subject matter expert, capable of managing a complex block of business while supporting the build-out of scalable stop-loss operations.

Key Responsibilities:

Placement & Renewal Management

• Lead or support the full stop-loss placement process: data collection, market submissions, quote analysis, and recommendation.
• Negotiate stop-loss contracts and renewals directly with carriers to ensure optimal pricing, terms, and coverage structures.
• Serve as a stop-loss lead on new business opportunities and client transitions from fully insured to self-funded arrangements.

Implementation & Carrier Coordination

• Oversee the stop-loss implementation process in coordination with TPAs and carrier partners, ensuring policies are issued accurately and on time.
• Review and reconcile contracts, disclosures, ASO provisions, and reimbursement terms for alignment and accuracy.
• Track all open implementation steps and ensure timely resolution of outstanding items.

Claims & Reimbursement Oversight

• Monitor large claims activity and work closely with TPAs and carriers to support timely reimbursement submissions and payments.
• Escalate and resolve reimbursement delays, gray-area claims, and negotiated settlements with carriers on behalf of clients.
• Maintain a reimbursement and claims resolution tracker and report out internally on status and risks.

Client Consulting & Account Management

• Manage a portion of the stop-loss book, including strategic guidance on renewals, plan design, captives, lasers, and risk mitigation strategies.
• Support monthly and quarterly reviews with account teams and clients; prepare client-ready deliverables.
• Serve as a subject matter expert on stop-loss topics in client and prospect meetings alongside account executives or producers.

Team Collaboration & Informal Leadership

• Help direct and manage workflow for junior team members or peers as assigned, ensuring timely, accurate delivery of client work.
• Provide training, coaching, and support on stop-loss fundamentals and best practices.
• Collaborate with internal teams (account management, actuarial, analytics, clinical) to ensure integrated service delivery.

Practice Development & Process Improvement

• Contribute to the development of standardized templates, reporting tools, and documentation procedures to improve efficiency and scale.
• Support ongoing refinement of carrier evaluation metrics and market intelligence.
• Participate in team planning sessions, business reviews, and feedback loops with leadership.

Qualifications

• Education: Bachelor's degree in Business Administration, Risk Management, Healthcare Administration, or related field. Equivalent experience may be considered.
• Experience: Minimum of 7 years in employee benefits, with at least 5 years of direct stop-loss consulting, underwriting, or carrier negotiation experience.
• Experience with a mix of fully insured, level-funded, and self-funded plans across multiple funding structures (ASO, minimum premium, captives).
• Familiarity with TPA models, ASO contract structures, and reimbursement mechanisms.
• Ability to interpret and explain stop-loss terms, underwriting decisions, and claim adjudication policies to internal and external stakeholders.
• Experience working with stop-loss platforms (e.g., Claros, Ringmaster) preferred.
• Proficiency in Excel, PowerPoint, and internal reporting tools.
• Excellent critical thinking, communication, and interpersonal skills.
• Current state insurance license (or ability to obtain within 90 days of hire).

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.