Stop Loss Analyst

About Lucent Health

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.

Company Culture

We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.

Honest

• Transparent Communication: be open and clear in all interactions without withholding crucial information
• Integrity: ensure accuracy in reporting, work outputs and any tasks assigned
• Truthfulness: provide honest feedback and report any issues or challenges as they arise
• Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior

Ethical

• Fair Decision Making: ensure all actions and decisions respect company policies and values
• Accountability: own up to mistakes and take responsibility for rectifying them
• Respect: treat colleagues, clients and partners with fairness and dignity
• Confidentiality: safeguard sensitive information and avoid conflicts of interest

Hardworking

• Consistency: meet or exceed deadlines, maintaining high productivity levels
• Proactiveness: take initiative to tackle challenges without waiting to be asked
• Willingness: voluntarily offer to assist in additional projects or tasks when needed
• Adaptability: work efficiently under pressure or in changing environments

Summary

The Stop Loss Analyst plays a pivotal role in managing financial risk associated with self-funded health plans. This position supports the underwriting and claims processes by evaluating large claims, tracking stop loss reimbursement trends, and ensuring accurate and timely submissions. Ideal candidates will combine analytical rigor with industry knowledge to protect the TPA and its clients from catastrophic claims exposure.

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

Qualifications

• Bachelor's degree in Business, Finance, Health Administration, or related field (preferred)
• 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 Qualifications

• 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

Equal Employment Opportunity Policy Statement

Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.