Position: Senior Stop Loss Operations Specialist
Department: Reinsurance
Reports To: Manager, Stop Loss Operations
FLSA Status: Non-exempt
Health Plans, Inc. (HPI) is a New England-based Third Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security.
Summary:
The Senior Stop Loss Operations Specialist is an experienced professional responsible for the accurate and timely preparation, submission, and reconciliation of stop‑loss filings (both specific and aggregate) for assigned groups. This role supports internal and external clients, mentors team members, conducts quality audits, and ensures compliance with stop loss policies, plan documents, and operational standards. The Specialist serves as a subject matter expert, collaborates across departments, and plays a key role in training, process improvement initiatives, and claims inventory preparation for monthly stop‑loss renewals.
Duties and Responsibilities (other duties may be assigned):
- Train new hires and provide ongoing training to reinsurance/stop‑loss staff.
- Coach analysts on best practices and standard operating procedures
- Provide subject matter support for staff questions
- Prepare and submit specific and aggregate stop‑loss reimbursement requests accurately and timely, following SOPs.
- Prepare and file weekly level funding accommodations, monthly aggregate accommodations, and annual aggregate filings.
- Administer advance funding when included in a group’s stop‑loss policy.
- Efficiently address questions and requests for information from the stop loss carriers and gather all supporting documentation from corresponding departments as necessary
- Correspond with clients to verify that enrollment eligibility was maintained based upon plan documentation
- Reconcile monthly and year end reporting to reflect reimbursements, refunds, voids, etc.
- Assist with researching and resolution of client issues related to stop loss transactions.
- Provide reporting to internal and external stakeholders as needed.
- Evaluate opportunities for process improvement and implement solutions that produce measurable results.
- Anticipate and understand systems interactions to improve efficiency and accuracy
Minimum Education Requirements:
- Associate’s degree or equivalent work experience.
Minimum Experience Requirements:
- 2+ years of experience in stop loss administration, self-funded health plans, finance operations, or a related role within a TPA, carrier, or benefits administration environment.
- Strong understanding of claims funding and stop loss workflows and financial controls.
- Working knowledge of traditional stop loss, captive stop loss, and/or level‑funded programs.
- Familiarity with banking processes, ACH funding, and reconciliation.
- Proficiency with shared inbox management, tracking tools, and reporting.
- Excellent organizational skills with the ability to manage multiple priorities and deadlines.
- Strong written and verbal communication skills, including professional client correspondence.
- High attention to detail and problem‑solving abilities.
- Work within specified timeframe and meet deadlines.
- Strong customer service orientation and ability to build relationships.
- Risk awareness and escalation judgment
- Demonstrated commitment to maintaining confidentiality and ethical practice.
Preferred Education Requirements:
Preferred Experience Requirements:
- Experience supporting self‑funded health plans and employer‑funded claim payment models.
- Experience in handling escalations or delinquent account management.
- Experience working directly with stop loss carriers, brokers, and employer groups.
- Familiarity with trend analysis, root cause analysis, or operational optimization initiatives.
- Proficiency with claims administration systems (Javelina) and financial tracking tools (Ringmaster).
- Experience with process improvement methodologies (Lean, Six Sigma, etc.).
Computer Skills:
- Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint
Reasonable Accommodation:
Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.
Working Environment/Physical Demands:
The work environment characteristics and physical demands described here are representative of those an employee may encounter while performing the duties of this job.
The noise level in the work environment is moderate. The employee may occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. While performing the duties of this job, the employee is regularly required to sit, walk, speak, or hear. The employee is frequently required to use hands or feel or handle items as well as reach with hands and arms. The employee is occasionally required to stand.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.
** Deadline to apply is 4/7/26***
Health Plans Inc. is an EEO – M/F/D/V employer