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Lucent Health · 1 week ago

Stop Loss Analyst

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

Lucent Health is a company focused on providing a data-driven care management solution for self-insured employers. The Stop Loss Analyst plays a pivotal role in managing financial risk associated with self-funded health plans by evaluating large claims and ensuring timely submissions for stop loss reimbursement.

Health CareMedicalRisk Management

Hiring Manager

Shanin Grimmett

Responsibilities

Evaluate large medical and pharmacy claims for stop loss reimbursement eligibility

Assist in preparation and submission of stop loss claims to carriers, ensuring compliance with contract terms

Monitor reimbursements and maintain status updates on pending claims

Collaborate with internal departments (Claims, Care Management, Finance) to gather documentation

Liaise with stop loss carriers to resolve claim issues and provide necessary support

Maintain detailed records in accordance with regulatory and HIPAA standards

Identify process inefficiencies and recommend improvements to optimize claims cycle time

Qualification

Stop loss claims experienceSelf-funded health plansAdvanced Excel skillsData analytics toolsICD-10CPT familiarityClaim adjudication systemsCommunication skillsOrganizational skillsProblem-solving mindset

Required

Bachelor's degree in Business, Finance, Health Administration, or related field

2+ years of experience in stop loss claims or TPA operations

Strong working knowledge of self-funded health plans and stop loss contracts

Advanced Excel skills; proficiency in data analytics tools a plus

Exceptional attention to detail and organizational skills

Excellent communication and relationship management abilities

Preferred

Familiarity with ICD-10, CPT, and medical coding terminology

Familiarity with LuminX or QicLink platforms

Ability to interpret legal and contractual language

Experience with claim adjudication systems or benefit platforms

Independent and proactive problem-solving mindset

Company

Lucent Health

As one of the nation’s largest independent TPAs, Lucent Health delivers vertically integrated health solutions, including plan administration, concierge care, pharmacy, and care management.

Founded in 2014

Nashville, Tennessee, USA

201-500 employees