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).