Senior Stop Loss Claims Analyst

Join Highmark Health as a Senior Stop Loss Claims Analyst in Baton Rouge, East Baton Rouge Parish. In this full-time role, you'll evaluate and process complex Stop Loss and reinsurance claims while fostering strong client partnerships and delivering strategic analysis on claim trends and risk exposures.

About the Role

As a Senior Stop Loss Claims Analyst, you are responsible for managing the complete lifecycle of Stop Loss (Excess Risk and Reinsurance) claims. You will review, evaluate, and process claims according to established quality standards and service-level agreements, ensuring accuracy and timely resolution. This position requires direct collaboration with clients to understand claim details, provide policy guidance, and deliver insights that help employers optimize their risk management strategies.

What You'll Do

• Review and evaluate Stop Loss and reinsurance claims for accuracy, completeness, and policy compliance
• Process claims within established turnaround timeframes while maintaining quality benchmarks
• Analyze client claim losses and identify patterns that inform client education and strategy
• Build and maintain positive relationships with client contacts, serving as a trusted resource for claim questions and industry guidance
• Investigate and resolve claim issues, including coverage disputes and complex underwriting questions
• Provide client education on Stop Loss program details, reinsurance mechanics, and claims procedures
• Document claim activities and decisions thoroughly in compliance with company protocols
• Escalate complex claims or compliance concerns to management as appropriate

What We're Looking For

• Proven experience analyzing and processing Stop Loss, excess liability, or reinsurance claims
• Strong knowledge of Stop Loss program structure, coverage, and underwriting principles
• Excellent communication skills and ability to explain complex policy concepts to diverse audiences
• Detail-oriented with demonstrated ability to meet deadlines and quality targets
• Analytical mindset with ability to identify trends and present data-driven insights
• Proficiency with claims management systems and standard office software
• Professional demeanor and ability to manage client relationships with integrity and care

About Highmark Health

Highmark Health is a leading healthcare company serving millions of members across multiple states. We remain committed to advancing health and delivering exceptional service to our employer and individual customers.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.