Stop Loss Manager bei Lucent Health

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 Manager of Stop Loss for Lucent oversees  all  aspects  of  stop  loss  claim  administration,  ensuring  accurate, timely, and compliant  handling  of  both  specific  and  aggregate  claims.  This leadership role requires strategic management of internal staff, coordination with carriers, clients, and brokers, and the continuous development and optimization of stop loss processes to mitigate financial risk for self-funded health plans.

Responsibilities 

• Team Leadership & Oversight
  • Supervise and mentor the stop loss claims team, providing guidance on complex cases and workflow management. 
• Conduct performance evaluations, identify training needs, and foster professional development.
• Implement best practices for auditing, quality assurance, and operational efficiency within the team.
• Stop Loss Administration
  • Oversee the preparation, submission, and follow-up of specific and aggregate stop loss claims to ensure timely reimbursement from carriers
  • Review high-dollar claims, coordinate advance funding, and monitor group and plan year-end claims activity.
  • Ensure compliance with stop loss policy contracts, regulatory guidelines, and internal SOPs.
• Client & Broker Engagement
  • Serve as primary point of contact for clients and brokers regarding stop loss claim inquiries, renewals, contract interpretations, and resolution of escalated issues.
  • Provide strategic risk analysis and reporting to support client decision-making and contractual obligations.
• Process Improvement & Compliance
  • Analyze team workflows and identify opportunities for process enhancements, automation, and efficiency gains.
  • Maintain accurate records, dashboards, and reporting of stop loss activity for leadership and carrier review.
  • Ensure adherence to HIPAA, ERISA, and applicable state and federal regulatory standards.
• Cross-Functional Collaboration
  • Work closely with finance, claims and client services to verify attachment points, contract alignment, and funding requirements.
  • Coordinate with internal departments to ensure seamless plan administration and claim resolution.
• Risk Management & Oversight
  • Monitor aggregate claim levels, policy limits, and excess exposure across the book of business. 
• Identify trends in stop loss claims to support predictive risk modeling and cost-containment strategies.

Qualifications 

• Education: Bachelor’s degree in business, healthcare administration, insurance, finance, or related field preferred. Equivalent experience considered. 
• Experience:
  • Minimum of 5–7 years of experience in self-funded healthcare, stop loss administration, or claims management.
  • Prior management or team lead experience in a TPA or insurance carrier environment is required. 
• Hands-on knowledge of specific and aggregate stop loss plans and administration.
• Skills & Competencies:
  • Strong leadership, communication, and interpersonal skills.
  • Proficiency in Microsoft Office Suite, including Excel for reporting and analysis.
  • High attention to detail with strong analytical and organizational capabilities.
  • Ability to manage multiple priorities under strict deadlines.
• Knowledge of regulatory compliance, underwriting principles, and TPA operations.

Preferred

• Experience implementing process improvements and quality control initiatives.
• Familiarity with stop loss software platforms and claims management systems.
• Strong client relationship management skills and ability to act as a subject matter expert.

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.