[Remote] Senior Stop Loss Consultant

Note: The job is a remote job and is open to candidates in USA. Higginbotham is a company focused on stop-loss consulting, and they are seeking a Senior Stop Loss Consultant to lead day-to-day execution and contribute to the development of their team structure and market positioning. The role involves managing stop-loss placements, client consulting, and overseeing workflows while also providing informal leadership and collaboration with internal teams.

Responsibilities

• 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
• Track all open implementation steps and ensure timely resolution of outstanding items
• Monitor large claims activity and work closely with TPAs and carriers to support timely reimbursement submissions and payments
• Escalate and resolve reimbursement delays, gray-area claims, and negotiated settlements with carriers on behalf of clients
• Maintain a reimbursement and claims resolution tracker and report out internally on status and risks
• Manage a portion of the stop-loss book, including strategic guidance on renewals, plan design, captives, lasers, and risk mitigation strategies
• Support monthly and quarterly reviews with account teams and clients; prepare client-ready deliverables
• Serve as a subject matter expert on stop-loss topics in client and prospect meetings alongside account executives or producers
• Help direct and manage workflow for junior team members or peers as assigned, ensuring timely, accurate delivery of client work
• Provide training, coaching, and support on stop-loss fundamentals and best practices
• Collaborate with internal teams (account management, actuarial, analytics, clinical) to ensure integrated service delivery
• Contribute to the development of standardized templates, reporting tools, and documentation procedures to improve efficiency and scale
• Support ongoing refinement of carrier evaluation metrics and market intelligence
• Participate in team planning sessions, business reviews, and feedback loops with leadership

Skills

• Bachelor's degree in Business Administration, Risk Management, Healthcare Administration, or related field. Equivalent experience may be considered
• 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
• Proficiency in Excel, PowerPoint, and internal reporting tools
• Excellent critical thinking, communication, and interpersonal skills
• Current state insurance license (or ability to obtain within 90 days of hire)
• Experience working with stop-loss platforms (e.g., Claros, Ringmaster) preferred

Company Overview