Amwins
Amwins A&H- Claims Manager, Stop Loss
600 University Street Suite 2100 Seattle, Washington 98101 · Senior
Sponsorship not specified$140k-$155kDetected 25 days ago
LeadershipCommunicationCollaborationMentoringActuarial ScienceUnderwriting
About the role
- Manager, Stop Loss Claims (Remote) Amwins Accident & Health Underwriters, formerly known as Beacon Risk Strategies, is conducting a search looking for an experienced Manager, Stop loss Claims.
- We provide a unique approach to even the most challenging risk.
- Expertise includes Medical Stop Loss, Hospital Indemnity Plans, and other niche A&H products.
Responsibilities
- Support loss mitigation and cost containment through industry knowledge and expertise.
- Perform monthly and year-end aggregate claim reporting audits and review prior to referral to senior management.
- Partner with internal teams to ensure consistent application of stop loss provisions and claims philosophy.
- Vendor & Partner Interaction
- Engage with TPAs, carriers, and external partners on complex claims matters as needed.
- Help manage, interpret and escalate reporting from TPA partners as needed.
- Support alignment between internal claims philosophy and external partner execution.
Requirements
- Bachelor's degree or equivalent experience required.
- Proven ability to apply sound, defensible judgment in non-standard claims scenarios where documentation is incomplete, facts are disputed, or precedent is unclear.
- Track record of serving as an escalation resource for complex claims issues, providing clear, well-reasoned recommendations to internal stakeholders.
- Experience mentoring or guiding other claims professionals through case review, technical coaching, or knowledge sharing.
- Strong written and verbal communication skills, with the ability to clearly explain complex claims determinations to varied audiences.
- Experience with Connexure, ESL Office software.
- 10+ years of hands-on medical stop loss claims experience, including responsibility for complex, high-dollar, and high-ambiguity claims and understanding of self-funded claim funding processes.
- Expert level understanding of physician and hospital billing practices, medical terminology, case management and utilization review reporting and industry claim processing best practices.
- Demonstrated expertise interpreting stop loss contracts, plan documents, and policy language, including exclusions, limitations, aggregating specifics, lasers, and reimbursement thresholds.
- Strong understanding of medical claims adjudication, including eligibility, coordination of benefits, medical necessity considerations, and primary drivers of large claims.
- Experience evaluating the financial impact of claims decisions, balancing contractual compliance, reimbursement outcomes, and long-term program integrity.
- History of working with multiple TPA claim administrators and demonstrated ability to understand different claim reporting templates and to identify gaps in reports across partners.
- Ability to collaborate effectively across functional departments including claims, underwriting, finance, legal, and operations without formal authority.
- Core Competencies
Compensation
- Amwins is the largest wholesale brokerage and group insurance administrator in the US; we are privately held with annual placed premiums over $45b, over 165+ locations around the world, 60 operating companies and employs over 8.1k people.
Benefits
- Amwins Accident & Health Underwriters, formerly known as Beacon Risk Strategies, is conducting a search looking for an experienced Manager, Stop loss Claims.
- As a specialty underwriter, distributor, and program manager, Amwins A&H focuses on medical stop-loss and other accident and health products.
- Please visit www.amwins.com/opco/amwins-accident-health-underwriters
- Review and evaluate claims requiring eligibility or medical necessity review, advanced contractual interpretation, medical judgment, or financial analysis.
- Contribute to the development of training content or informal learning sessions as appropriate.
- Stay abreast of industry changes as related to emerging medical and pharmacy trends as well as cost containment solutions.
- Amwins Accident & Health (Amwins A&H) has primary locations in Seattle, WA and Atlanta, GA, and is a managing underwriter for several key carrier partners.
Company info
- Our employees pride themselves on prompt, personalized service and our customers have direct access to the claims and underwriting teams.
This listing is sourced directly from Amwins's careers page and normalized into a canonical job model.