Senior Stop Loss Consultant

Higginbotham

Senior Stop Loss Consultant managing stop-loss placements and client consulting for healthcare plans. Overseeing implementation, claims monitoring, and team collaboration to enhance operational efficiency.

Posted 6/10/2026full-timeRemote • Texas • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Lead or support the full stop-loss placement process: data collection, market submissions, quote analysis, and recommendation.
Negotiate stop-loss contracts and renewals directly with carriers to ensure optimal pricing, terms, and coverage structures.
Serve as a stop-loss lead on new business opportunities and client transitions from fully insured to self-funded arrangements.
Oversee the stop-loss implementation process in coordination with TPAs and carrier partners, ensuring policies are issued accurately and on time.
Review and reconcile contracts, disclosures, ASO provisions, and reimbursement terms for alignment and accuracy.
Monitor large claims activity and work closely with TPAs and carriers to support timely reimbursement submissions and payments.
Manage a portion of the stop-loss book, including strategic guidance on renewals, plan design, captives, lasers, and risk mitigation strategies.
Help direct and manage workflow for junior team members or peers as assigned, ensuring timely, accurate delivery of client work.
Contribute to the development of standardized templates, reporting tools, and documentation procedures to improve efficiency and scale.

Requirements

What you’ll need

Bachelor’s degree in Business Administration, Risk Management, Healthcare Administration, or related field
Minimum of 7 years in employee benefits, with at least 5 years of direct stop-loss consulting, underwriting, or carrier negotiation experience
Experience with a mix of fully insured, level-funded, and self-funded plans across multiple funding structures (ASO, minimum premium, captives)
Familiarity with TPA models, ASO contract structures, and reimbursement mechanisms
Ability to interpret and explain stop-loss terms, underwriting decisions, and claim adjudication policies to internal and external stakeholders
Experience working with stop-loss platforms (e.g., Claros, Ringmaster) preferred
Proficiency in Excel, PowerPoint, and internal reporting tools
Current state insurance license (or ability to obtain within 90 days of hire)

Benefits

Comp & perks

Equal Opportunity Employer

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

stop-loss consultingunderwritingcarrier negotiationdata collectionquote analysiscontract reconciliationclaims monitoringrisk mitigation strategiesplan designreimbursement mechanisms

Soft Skills

leadershipcommunicationworkflow managementstrategic guidanceteam collaborationclient relationship managementproblem-solvingattention to detailorganizational skillsefficiency improvement

Certifications

Bachelor’s degreestate insurance license