claims analyst

Plymouth Rock Assurance

<div>
 <p>
  The Claims Analyst supports the Claims Department&rsquo;s Operations and Management Teams by developing/maintaining or supporting business reports, applications, and analytical solutions. This role participates in systems implementations, data management initiatives, and analytics work that strengthens Plymouth Rock&rsquo;s performance in loss management, customer service, expense control, and employee engagement.
 </p>
 <p>
 </p>
 <p>
  RESPONSIBILITIES
 </p>
 <ul>
  <li>
   Partner with Claims leadership and cross-functional teams to deliver recurring reports/visuals and ad hoc datasets using SQL Server Management Studio, Visual Studio, MS Access, Excel and Tableau.
  </li>
  <li>
   Manage the claim department&rsquo;s letter library using low code/no code third party vendor software, including creating/updating letters and creating/maintain automated batch jobs.
  </li>
  <li>
   Collaborate with IT on claims technology initiatives, including but not limited to providing subject matter expertise, writing business requirements, performing user acceptance testing, training and postproduction support.
  </li>
  <li>
   Oversee regulatory reporting automated process and ensure compliance within the department.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  QUALIFICATIONS
 </p>
 <ul>
  <li>
   Bachelor&rsquo;s degree required, master&rsquo;s degree preferred, ideally in a technical or analytical discipline (Computer Science, Engineering, Mathematics, Statistics).
  </li>
  <li>
   1-2 years&rsquo; experience with SQL, including writing complex queries, stored procedures, and functions.
  </li>
  <li>
   Proficient in Microsoft applications including Word, Excel, Access and Visual Studio.
  </li>
  <li>
   Experience in SSIS package development a plus.
  </li>
  <li>
   Business intelligence development experience (Tableau preferred)
  </li>
  <li>
   Previous experience in an insurance industry preferred.
  </li>
  <li>
   Strong analytical, problem-solving and attention-to-detail skills.
  </li>
  <li>
   Excellent written and verbal communication skills
  </li>
  <li>
   Self-motivated, organized and able to prioritize in a fast-paced environment.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  SALARY RANGE
 </p>
 <p>
  The pay range for this position is $ 63,500 to $88,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
 </p>
 <p>
  <br/>
 </p>
 <p>
  PERKS &amp; BENEFITS
 </p>
 <ul>
  <li>
   4 weeks accrued paid time off, 8 paid national holidays per year, and 2 floating holidays
  </li>
  <li>
   Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
  </li>
  <li>
   Annual 401(k) Employer Contribution
  </li>
  <li>
   Free onsite gym and health center at our Woodbridge Location
  </li>
  <li>
   Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
  </li>
  <li>
   Robust health and wellness program and fitness reimbursements
  </li>
  <li>
   Various Paid Family leave options including Paid Parental Leave
  </li>
  <li>
   Tuition Reimbursement
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  ABOUT THE COMPANY
 </p>
 <p>
  <em>
   The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner&rsquo;s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of &ldquo;A-/Excellent&rdquo;.
  </em>
 </p>
 <p>
  <em>
   #LI-DNI
  </em>
 </p>
</div>


Claims Analyst

Risk Strategies

<div><div><div>The Claims Specialist plays a key role in delivering an exceptional customer experience by thoroughly investigating, evaluating, and processing insurance claims within established authority levels. This individual collaborates closely with policyholders, providers, and internal partners to drive timely, accurate, and compliant claim resolutions.</div><div></div><div>
Your Impact:</div><ul><li>
Evaluate and process claims by reviewing documentation for accuracy, completeness, and adherence to policy and regulatory requirements.</li><li>
Analyze claim trends and data to identify discrepancies, patterns, and opportunities for improvement.</li><li>
Prepare clear, actionable reports that summarize findings, insights, and recommendations for leadership.</li><li>
Partner with cross-functional teams to resolve complex claim issues, streamline workflows, and enhance the customer experience.</li><li>
Stay current on industry regulations, guidelines, and best practices to ensure ongoing compliance and operational excellence.</li></ul><div></div><div>
Successful Candidates Will Have:</div><ul><li>
Bachelor&rsquo;s degree or equivalent work experience.</li><li>
2&ndash;4 years of claims handling or related insurance experience.</li><li>
Strong understanding of claims processes, industry standards, and regulatory requirements.</li><li>
Exceptional attention to detail, analytical thinking, and customer service skills.</li></ul></div><div></div><div>
Physical Demands and Work Environment:</div><div></div><div><br>
The employee must be able to effectively manage the demands of a fast-paced work environment. This includes the ability to adapt to changing priorities, handle multiple tasks simultaneously, and maintain composure under pressure while meeting deadlines and performance expectations.<br>
<br>
This position requires the ability to sit and work at a computer for extended periods of time. The employee must be able to focus on tasks involving prolonged screen time and perform repetitive motions such as typing and mouse use in a standard office environment. Regular phone communication is an essential part of this role. The employee must be able to make and receive calls as part of their daily responsibilities, communicate effectively and professionally, and provide accurate information in a clear and courteous manner.</div><div></div><div>
Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: <div>www.risk-strategies.com/careers</div>.</div><div></div><div>
Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' <div>California Job Applicant Privacy Notice</div>.</div></div>

ProspectBlue

<div>
 <p>
  Position Overview
 </p>
 <p>
  <br/>
 </p>
 <p>
  ProspectBlue is seeking a Risk &amp; Claims Analyst for their client in the logistics and transportation industry. This individual will play a key role in investigating cargo and equipment incidents, managing claims, and supporting overall risk mitigation efforts across the organization.
 </p>
 <p>
  <br/>
 </p>
 <p>
  This position is highly cross-functional and requires strong analytical skills, attention to detail, and the ability to communicate effectively with both internal teams and external partners.
 </p>
 <p>
  <br/>
 </p>
 <p>
  Key Responsibilities
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Investigate cargo-related incidents by reviewing shipment details including commodity, packaging, weight, hazardous classification, and container history
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Analyze documentation, photos, and operational records to determine root cause and responsible parties
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Manage cargo claims from initial review through resolution, including validation, coordination with stakeholders, and invoicing
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Coordinate third-party surveys and ensure findings are incorporated into claims evaluations
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Partner with internal teams across operations, customer service, equipment, and finance to resolve issues and improve processes
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Communicate professionally with customers, vendors, and external partners regarding claims and investigation outcomes
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Ensure compliance documentation is accurate and up to date, including insurance, DOT/SCAC registrations, and interchange agreements
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Identify trends in incidents and provide insights to support operational improvements and risk mitigation
 </p>
 <p>
  <br/>
 </p>
 <p>
  Qualifications
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Bachelor&rsquo;s degree or equivalent work experience
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Experience in logistics, transportation, cargo claims, or risk management preferred
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Exposure to ocean freight, NVOCC/liner operations, or supply chain environments is a plus
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Strong analytical and problem-solving skills with high attention to detail
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Ability to manage multiple priorities in a fast-paced environment
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Proficiency in Microsoft Office and ability to learn internal systems
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Strong written and verbal communication skills
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Ability to work both independently and collaboratively
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Must be authorized to work in the U.S. and eligible to obtain a TWIC card
 </p>
 <p>
  <br/>
 </p>
 <p>
  Additional Information
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Standard business hours (8:00 AM &ndash; 5:00 PM)
 </p>
 <p>
  <br/>
 </p>
 <p>
  &bull; Professional office environment with limited travel as needed
 </p>
</div>


Risk & Claims Analyst

Allied World Assurance Company

<div><div><b>Sr. Claims Analyst, Excess Casualty, North American Claims Group</b> <b>-</b> <b>(</b><b>2600001A</b><b>)</b></div><div><b>
Description</b><div></div><div><div><p><b><br>
Job Summary:</b></p><p><br>
Investigate, evaluate, and resolve claims made against the Company&rsquo;s Umbrella and Excess General Liability policies. Engage in collaborative projects in support of other areas of the company, including underwriting, finance, actuarial, operations, and technology. Provide superior service to all customers, whether internal or external.</p></div><p></p><div><p><b><br>
Job Duties</b></p><div><ul><li><p><br>
Efficiently manage a vigorous load of claims involving a broad spectrum of accounts and coverages. Promptly analyze coverage, draft accurate and timely coverage positions, and manage litigation by effectively interacting with insureds, brokers, defense counsel and other parties as required. Represent Company in the resolution of claims and participate in legal proceedings, including mediations.</p></li></ul><ul><li> Work with other areas of the Company including underwriting, finance and accounting, actuarial, operations and technology on projects as requested. Prepare claim summaries and other reports as necessary for management.</li></ul><ul><li> Meet with existing or prospective clients and brokers. Attend relevant industry conferences/meetings.</li></ul><ul><li> Comply with CMS reporting.</li></ul></div></div></div><div><br>
</div></div><div><b>
Qualifications</b><div></div><div><div><p><b><br>
Job Requirements:</b></p><div><ul><li><br>
 Minimum of 5-7 years&rsquo; experience handling Casualty claims or related relevant experience. Four-year college degree is required, but a J.D. is preferred.</li></ul><ul><li> Excellent negotiation and communication skills. Some technical writing experience.</li></ul><ul><li> Ability to accurately and timely analyze coverage and instruct and collaborate with counsel regarding litigation strategy and claim resolution, resolve claims and otherwise act within the scope of delegated authority.</li></ul></div></div><div><p><b><br>
Special Responsibilities:</b></p><ul><li><br>
 Work requires the ability to quickly and accurately read, comprehend, analyze and produce written materials and to use a computer for long periods of time. Some travel required.</li></ul></div><br>
</div><p><b>
Compensation:</b></p><p>
The below annualized base pay range is a broad range based on analysis of similar positions in the market. The actual base pay for the position may be above or below the listed range and determined by a number of considerations, including but not limited to complexity, location, and scope of the role, along with experience, skills, education, training, and other conditions of employment. Base salary represents one component of Allied World&rsquo;s comprehensive total reward package, which may also include annual incentive compensation rewards.</p><p>
Salary range: $115,000.00 - $125,000.00</p><p>
Allied World Assurance Company Holdings, Ltd, through its subsidiaries, is a global provider of insurance and reinsurance solutions. We operate under the brand Allied World and have supported clients, cedents and trading partners with thoughtful service and meaningful coverages since 2001. We are a subsidiary of Fairfax Financial Holdings, Limited and benefit from a strong capital base and a worldwide network of affiliated entities that allow us to think and respond in non-traditional ways.</p><p>
Our generous benefits package includes: Health, Dental and Disability Insurance, a company match 401k plan, and Group Term Life Insurance. Allied World is an Equal Opportunity Employer. All qualified applicants will be considered for employment without consideration of any disability, veteran status or any other characteristic protected by law.</p><p>
To learn more, visit awac.com, or follow us on Facebook at facebook.com/alliedworld and LinkedIn at linkedin.com/company/allied-world.</p><p></p><div><br>
</div></div><div><b>
Primary Location</b><b>:</b> US-CT-Farmington</div><div><b>
Other Locations</b><b>:</b> US-NY-New York, US-NY-Jericho</div><div><b>
Work Locations</b><b>:</b> Farmington 1690 New Britain Avenue Suite 101 Farmington 06032</div><div><b>
Job</b><b>:</b> Claims</div><div><b>
Employee Status</b><b>:</b>Regular</div><div><b>
Job Type</b><b>:</b>Standard</div><div><b>
Job Posting</b><b>:</b> Mar 13, 2026, 3:58:29 PM</div><div><b>
Pay Basis</b>Yearly</div></div>

Sr. Claims Analyst

UMB Bank

<div>
 Our
 <strong>
  Enterprise Fraud Claims
 </strong>
 team is responsible for formally investigating all unauthorized transactions focusing on protecting customer assets, secure compromised accounts, and recover stolen funds.
 <br/>
 <br/>
 As the
 <strong>
  Fraud Claims Analyst
 </strong>
 , your focus is toward investigating fraudulent confirmations against customers and the UMB organization. You will take on fraud claims for all payment channels that our customers utilize throughout the organization. You are the determining factors in making vital decisions for determining how fraud is happening, where it is happening, and how they can put a stop to it. You will work closely within their team environment to support one another and to be successful. While working across multiple departments, you will help customers and UMB get millions of dollars in loss back. This is a subset of the overall responsibilities which will include multiple initiatives as assigned by Bank Operations leadership.
 <br/>
 <br/>
 <strong>
  This role is hybrid (Mon through Thu on-site / Fri remote; 900 &ndash; 500 PM) at the UMB Technology &amp; Operations Center located in downtown Kansas City, MO.
  <br/>
  <br/>
 </strong>
 <strong>
  How You&rsquo;ll Spend Your Time
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage multi-channel fraud claims.
  </li>
  <li>
   Continually evaluate the effectiveness of existing case management tools and identify to the Manager, Fraud Claims of performance gaps or defects.
  </li>
  <li>
   Adhere to the applicable regulatory requirements governing fraud claims for checks, ACH, and wire.
  </li>
  <li>
   Ensure compliance with Bank standards, policies, and procedures.
  </li>
  <li>
   Work closely with the Enterprise Fraud Data Strategy team to produce appropriate data and reporting to fulfill overall business needs and expectations.
  </li>
  <li>
   Work closely with the Fraud Prevention Team and Line of Business (LOB) partners to identify adverse impacts to customers, provide solutions, and implement changes to ensure the best customer experience.
  </li>
  <li>
   Communicate regularly with peer banks and industry organizations to maintain awareness of industry risks and trends.
  </li>
  <li>
   Stay current with UMB&rsquo;s fraud policies and procedures.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  <em>
   We&rsquo;re excited to talk if you have
   <br/>
   <br/>
  </em>
 </strong>
 <ul>
  <li>
   At least 2 years of fraud claim processing or fraud operations experience in check, ACH or wire.
  </li>
  <li>
   Knowledge of NACHA rules and the Uniform Commercial Code as they apply to case management and recovery actions.
  </li>
  <li>
   Strong problem-solving skills to investigate fraudulent claims against our customers and the UMB organization.
  </li>
  <li>
   Excellent communication skills to provide updated information to parties to ensure all information is communicated for adequate research for fraud.
  </li>
  <li>
   Team-focused approach to work out solutions within your team to help conduct plans and research to stop and defeat fraud.
  </li>
  <li>
   Experience with Microsoft 365 applications.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  <em>
   Bonus Points if you have
   <br/>
   <br/>
  </em>
 </strong>
 <ul>
  <li>
   Cross payment multi-channel fraud experience.
  </li>
  <li>
   Experience with Oasis, Hogan, NICE Actimize, or FIS Systems.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Applicants must have legal authority to work in the United States. Work Visa sponsorship is not available for this position.
  <br/>
  <br/>
 </strong>
 <strong>
  Compensation Range
  <br/>
  <br/>
 </strong>
 $44,790.00 - $86,510.00
 <br/>
 <br/>
 <em>
  The posted compensation range on this listing represents UMB&rsquo;s standard for this role, but the actual compensation may vary by geographic location, experience level, and other job-related factors. In addition, this range does not encompass the full earning potential for this role. Please see the description of benefits included with this job posting for additional information
  <br/>
  <br/>
 </em>
 UMB offers competitive and varied benefits to eligible associates, such as Paid Time Off; a 401(k) matching program; annual incentive pay; paid holidays; a comprehensive company sponsored benefit plan including medical, dental, vision, and other insurance coverage; health savings, flexible spending, and dependent care accounts; adoption assistance; an employee assistance program; fitness reimbursement; tuition reimbursement; an associate wellbeing program; an associate emergency fund; and various associate banking benefits. Benefit offerings and eligibility requirements vary.
 <br/>
 <br/>
 <strong>
  Are you ready to be part of something more?
  <br/>
  <br/>
 </strong>
 You're more than a means to an end&mdash;a way to help us meet the bottom line. UMB isn't comprised of workers, but of people who care about their work, one another, and their community. Expect more than the status quo. At UMB, you can expect more heart. You'll be valued for exactly who you are and encouraged to support causes you care about. Expect more trust. We want you to do the right thing, no matter what. And, expect more opportunities. UMBers are known for having multiple careers here and having their voices heard.
 <br/>
 <br/>
 <em>
  UMB and its affiliates are committed to inclusion and diversity and provide employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex (including gender, pregnancy, sexual orientation, and gender identity), national origin, age, disability, military service, veteran status, genetic information, or any other status protected by applicable federal, state, or local law. If you need accommodation for any part of the employment process because of a disability, please send an e-mail to talentacquisition@umb.com to let us know the nature of your request.
  <br/>
  <br/>
 </em>
 <em>
  If you are a California resident, please visit our
 </em>
 Privacy Notice for California Job Candidates
 <em>
  to understand how we collect and use your personal information when you apply for employment with UMB.
 </em>
</div>


Fraud Claims Analyst

UnitedHealthcare

<div><p><i>This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.</i></p><p>
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start <b>Caring</b>. <b>Connecting</b>. <b>Growing together</b></p><p>
Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjudicating Life claims. Authorizes the appropriate payment or refers claims to Team Lead or Manager for validation of adverse or over limit approvals.</p><p>
This position is full-time (40 hours/week). Employees are required to work our normal business hours of 7:00am - 6:00pm EST. Core hours business hours are 9:00 am - 4:00 pm EST.</p><p>
We offer 2 - 3 months of paid training. The hours during training will be aligned with their schedule. Training will be conducted virtually from your home.</p><p></p><p><b><br>
Primary Responsibilities:</b></p><ul><li>
Review and render determinations on Life claims</li><li>
Initiate and maintain appropriate level of communication within ERISA standards through the claim review and investigation process</li><li>
Respond to all inquiries generated relative to Life claims within established service timeframe</li><li>
Provide accurate claim decisions in accordance with Policy, State and Federal guidelines</li><li>
Adjudicate Life claims with current average volumes of 50 claims weekly</li></ul><p></p><p><br>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.</p><p><b>
Required Qualifications:</b></p><ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR Older</li><li>
2+ years of experience in Customer Service, including analyzing and problem-solving issues for policyholders, employers, for both internal and external customers</li><li>
2+ years of recent experience in life claims processing</li><li>
Proficiency with computer and Windows personal computer applications, which includes the ability to navigate and learn new and complex computer system applications</li><li>
Ability to work our normal business hours of 7:00am - 6:00pm EST. Core hours business hours are 9:00 am - 4:00 pm EST.</li></ul><p></p><p><b><br>
Preferred Qualifications:</b></p><ul><li>
OnBase claims processing system experience</li></ul><p></p><p><b><br>
Telecommuting Requirements:</b></p><ul><li>
Ability to keep all company sensitive documents secure (if applicable)</li><li>
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.</li><li>
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.</li></ul><p></p><ul><li><br>
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul><p></p><p><br>
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 - $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.</p><p></p><p><b><i><br>
Application Deadline:</i></b><i> This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.</i></p><p></p><p><i><br>
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.</i></p><p></p><p><i><br>
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></p><p></p><p><i><br>
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.</i></p></div>

Life Claims Analyst

Acrisure LLC

<div></div><div><div>About Acrisure</div><div>
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services &ndash; and more.</div><div>
In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.</div><ul><li>Position is location-flexible. Locations listed are primary locations. Applicants from additional locations will be considered.</li></ul><div>
Job Summary</div><div>
The Stop Loss Claims Analyst plays a critical role within a Managing General Underwriter (MGU), serving as the liaison between carriers, TPAs, brokers, and employer groups. This position is responsible for the detailed review, analysis, and adjudication of specific and aggregate stop loss claims in accordance with issued policy terms and carrier guidelines.</div><div>
Because MGUs operate at the intersection of underwriting, carrier oversight, and client service, this role requires exceptional communication skills, strong contract interpretation expertise, and the ability to navigate complex claim situations with professionalism and clarity.</div><div>
Responsibilities</div><ul><li>
Review and adjudicate specific and aggregate stop loss claims according to issued policy terms and carrier authority guidelines.</li><li>
Interpret complex stop loss contracts</li><li>
Analyze large claimant reports, paid claims data and supporting medical documentation</li><li>
Calculate reimbursement amounts and prepare payment recommendations for carrier approval (as applicable under authority limits).</li><li>
Ensure claims are processed within authority levels and escalate appropriately when required.</li><li>
Serve as the primary point of contact for TPAs regarding documentation, eligibility issues, and claim clarification.</li><li>
Communicate claim determinations clearly and professionally to brokers and clients.</li><li>
Draft detailed claim correspondence outlining reimbursement calculations and contract rationale.</li><li>
Collaborate closely with underwriting to flag emerging large claim trends and renewal considerations.</li><li>
Coordinate with carrier partners on high-dollar or complex claims requiring review.</li><li>
Proactively follow up on outstanding documentation to maintain service standards and turnaround expectations.</li><li>
Participate in broker calls when needed to explain complex claim determinations.</li></ul><div></div><div>
Requirements</div><ul><li>
3+ years of stop loss claims experience within a carrier, MGU, or TPA environment.</li><li>
Strong understanding of self-funded health plans and stop loss policy structure.</li><li>
Proven ability to interpret and apply complex contract language.</li><li>
Experience working directly with brokers, TPAs, and carrier partners.</li><li>
Advanced proficiency in Microsoft Excel (pivot tables, data reconciliation, reporting).</li><li>
Exceptional written and verbal communication skills.</li></ul><div></div><div>
Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.</div><div></div><div><br>
Why Join Us:</div><div>
At Acrisure, we&rsquo;re building more than a business, we&rsquo;re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.</div><div></div><div>
Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.</div><div></div><div><br>
Employee Benefits</div><div>
We also offer our employees a comprehensive suite of benefits and perks, including:</div><ul><li><div>
Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.</div></li><li><div>
Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.</div></li><li><div>
Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.</div></li><li><div>
Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.</div></li><li><div>
&hellip; and so much more!</div></li></ul><div><i>
This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.</i></div><div></div><div><br>
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting <i>leaves@acrisure.com</i>.</div><div></div><div>
Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.</div><div></div><div><br>
California Residents: Learn more about our privacy practices for applicants by visiting the <div>Acrisure California Applicant Privacy Policy</div>.</div><div></div><div><br>
Recruitment Fraud: Please visit here to learn more about our <div>Recruitment Fraud Notice</div>.</div><div></div><div><br>
Welcome, your new opportunity awaits you.</div></div><div></div>

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