Stop Loss Operations Specialist (Health Insurance)

Location: Fully remote, but candidates must be US based and able to comply with company policies such as HIPAA. A quiet, distraction-free workspace, reliable internet, VPN use, secure passwords, and company-approved devices/software are required.

Company

hirify.global uses technology and clinical expertise to improve healthcare cost, quality, access, utilization, and payment integrity for employers, brokers, payers, and providers.

What you will do

• Manage stop loss premium administration, including receipts, lockbox and ACH activity, premium application, enrollment reconciliation, and resolution of shortages, overpayments, unapplied cash, and delinquent premium.
• Coordinate return premiums, commissions, overrides, claim payments, month-end close, bordereaux, carrier reporting, and related financial documentation.
• Manage policy administration after underwriting approval, including policy and form selection, preparation, amendments, endorsements, outstanding-item tracking, and issuance coordination.
• Review policy materials against underwriting terms, including deductibles, aggregate provisions, contract basis, lasers, exclusions, effective dates, terminal liability provisions, and special endorsements.
• Administer agency and producer licensing, carrier appointments, renewals, state-specific requirements, regulatory correspondence, and TPA and producer due diligence documentation.
• Maintain procedures, controls, exception reporting, audit evidence, operational reporting, and process improvements while coordinating with Underwriting, Claims, Finance, TPAs, producers, carriers, and Stop Loss leadership.

Requirements

• 3+ years of experience in insurance operations, premium administration, accounting or reconciliation, policy administration, or a related field.
• Working knowledge of self-funded medical plans, employer stop loss terminology, insurance contracts, and operational workflows.
• Strong reconciliation, analytical, organizational, time-management, written communication, and verbal communication skills.
• Ability to work accurately across premium, enrollment, policy, and financial data; interpret policy and underwriting terms; and identify discrepancies requiring review.
• Experience managing financial or administrative processes with defined controls, deadlines, and documentation requirements.
• Ability to maintain accurate, complete, and audit-ready records and independently manage assigned operational processes within established procedures.
• Ability to collaborate with carriers, TPAs, producers, Finance, Underwriting, Claims, and internal partners, and appropriately escalate material exceptions.
• Proficiency with Microsoft Office, including Excel and Word, and ability to learn stop loss administration, underwriting, and reporting platforms.

Nice to have

• Bachelor’s degree in Accounting, Finance, Business, Insurance, or a related field.
• Experience with employer stop loss, self-funded medical plans, premium administration, or policy issuance.
• Experience with carrier bordereaux, month-end reconciliation, insurance financial reporting, insurance licensing, carrier appointments, producer records, or regulatory requirements.
• Experience preparing policies, endorsements, amendments, or reviewing insurance documents for quality.
• Experience with TPA or producer due diligence, approval processes, carrier or financial audits, compliance audits, or operational audits.
• Experience with stop loss administration, underwriting, policy, or reporting platforms.

Culture & Benefits

• Fully remote work with company-provided equipment, a flexible working environment, and required adherence to security protocols.
• Medical, dental, and vision insurance; HSA, FSA, and DCFSA options.
• 401(k) with company match and immediate vesting.
• Paid vacation, sick leave, holidays, maternity leave, and paternity leave.
• Employee Assistance Program, pet insurance, employee discounts, and paid time off for philanthropic activities.
• Work guided by collaboration, performance, transparency, trust, inclusion, and equal employment opportunity.