Stop Loss Claims Analyst

About Acrisure

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 – and more.

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.

• Position is location-flexible. Locations listed are primary target locations. Applicants from additional locations will be considered.

Job Summary

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.

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.

Responsibilities

• Review and adjudicate specific and aggregate stop loss claims according to issued policy terms and carrier authority guidelines.
• Interpret complex stop loss contracts
• Analyze large claimant reports, paid claims data and supporting medical documentation
• Calculate reimbursement amounts and prepare payment recommendations for carrier approval (as applicable under authority limits).
• Ensure claims are processed within authority levels and escalate appropriately when required.
• Serve as the primary point of contact for TPAs regarding documentation, eligibility issues, and claim clarification.
• Communicate claim determinations clearly and professionally to brokers and clients.
• Draft detailed claim correspondence outlining reimbursement calculations and contract rationale.
• Collaborate closely with underwriting to flag emerging large claim trends and renewal considerations.
• Coordinate with carrier partners on high-dollar or complex claims requiring review.
• Proactively follow up on outstanding documentation to maintain service standards and turnaround expectations.
• Participate in broker calls when needed to explain complex claim determinations.

Requirements

• 3+ years of stop loss claims experience within a carrier, MGU, or TPA environment.
• Strong understanding of self-funded health plans and stop loss policy structure.
• Proven ability to interpret and apply complex contract language.
• Experience working directly with brokers, TPAs, and carrier partners.
• Advanced proficiency in Microsoft Excel (pivot tables, data reconciliation, reporting).
• Exceptional written and verbal communication skills.

Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

Why Join Us:

At Acrisure, we’re building more than a business, we’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.

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.

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks, including:

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• 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.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• … and so much more!

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.

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 leaves@acrisure.com.

Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

Welcome, your new opportunity awaits you.