Role Description The Manager, Stop Loss Claims, will play a critical role in supporting the A&H claims organization by performing claims adjudication functions, managing complex, high-dollar and high-ambiguity stop loss claims, employing cost containment solutions, serving as a senior escalation point, and applying expert judgment to drive consistent, high-quality outcomes. This role will be responsible for some personal claims production including, but not limited to, high dollar and complex stop loss claim reimbursement requests and will assist with overall claims department operations. It is designed to complement current claims leadership by adding depth of expertise, decision-making capacity, and mentorship through influence and credibility. Responsibilities - Stop Loss Claims Oversight - Serve as a senior escalation point for complex, high-dollar, or high-risk stop loss claims. - Review and evaluate claims requiring eligibility or medical necessity review, advanced contractual interpretation, medical judgment, or financial analysis. - Apply expert judgment to claim decisions that materially impact financial outcomes. - Identify trends, risks, and opportunities related to claim determinations and outcomes. - Support loss mitigation and cost containment through industry knowledge and expertise. - Participate in daily claim processing, escalated claim reviews and decision making. - 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. - Collaboration & Influence - Work closely with existing management, claims leadership, underwriting, and operations teams. - Provide insight and recommendations on claims-related matters that influence pricing, program structure, and risk assessment. - Function as a trusted internal resource for complex claims discussions and decision-making. - Assist underwriting department in setting reserves for ongoing claimants. - Mentorship & Knowledge Sharing - Mentor and coach claims professionals through guidance, case review, and knowledge sharing. - Contribute to the development of training content or informal learning sessions as appropriate. - Elevate claims capability across the organization by sharing best practices and technical expertise. - 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. - Stay abreast of industry changes as related to emerging medical and pharmacy trends as well as cost containment solutions. Qualifications - Bachelor’s degree or equivalent experience required. - 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. - Proven ability to apply sound, defensible judgment in non-standard claims scenarios where documentation is incomplete, facts are disputed, or precedent is unclear. - 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. - Track record of serving as an escalation resource for complex claims issues, providing clear, well-reasoned recommendations to internal stakeholders. - Ability to collaborate effectively across functional departments including claims, underwriting, finance, legal, and operations without formal authority. - 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. Core Competencies - Stop Loss Claims Judgment: Applies consistent, defensible judgment in complex and high dollar stop loss claims through accurate interpretation of contract language, plan provisions, and medical documentation. - Technical Contract Interpretation: Demonstrates deep expertise in stop loss contracts and plan documents, including exclusions, limitations, aggregating specifics, lasers, and reimbursement thresholds. - Financial Impact Evaluation: Assesses the financial implications of claims decisions, balancing contractual compliance, reimbursement outcomes, and long-term program integrity. - Escalation & Decision Ownership: Serves as a senior escalation point for ambiguous or disputed claims, providing clear recommendations and owning decisions through resolution. - Comfort with Ambiguity: Operates effectively in non-standard claims scenarios where facts, documentation, or precedent are incomplete or conflicting. - Influence Through Expertise: Elevates claims quality and consistency through technical credibility, mentorship, and collaboration rather than positional authority. Compensation Pursuant to Washington regulation, the compensation range for this position is as stated and includes eligibility for performance-based bonuses. Washington Pay Range: $140,000 — $155,000 USD

• Lead engagement with NASTAD’s members as well as state and local health departments, serving as the primary point of contact and providing technical assistance and subject matter expertise on systems coordination and stakeholder engagement. • Contribute to the design, planning, and facilitation of meetings and in person convenings related to health systems collaboration, including internal planning sessions and stakeholder meetings. • Develop agendas and coordinate logistics for meetings to support cross-functional collaboration and project planning. • Develop content and deliver presentations for internal and external stakeholders, including funders, partners, and public health peers via webinars, office hours, and other virtual learning opportunities. • Track activities and key performance metrics using project management tools. • Manage program workplans by monitoring project milestones, tracking progress of activities, sending timely alerts for upcoming start and end dates, providing reminders to responsible parties, and delivering regular updates on accomplishments and status to ensure activities remain on schedule and objectives are met. • Develop tools, templates, guides, and other practical resources to support jurisdictions. • Oversee the process of disseminating tools and materials to our stakeholders, leveraging technology platforms, ensuring timely and accurate delivery of materials.

• Manage and monitor bankruptcy case progress, ensuring deadlines, filings, and hearings are handled on time. • Prepare, organize, and submit required legal documentation in accordance with court requirements. • Maintain accurate and up-to-date case records within the case management system. • Act as the main point of contact for clients, providing updates and responding to inquiries professionally. • Coordinate communication between clients, attorneys, courts, and trustees to ensure smooth case progression.

Role Description The Regional Sales Manager is a crucial member of the Amwins Connect high performing growth and revenue generating team. We are seeking a Regional Sales Manager to play a key role in developing, maintaining, and growing retail broker relationships. The role requires managing, negotiating, and advising brokers with a consultative approach. Position requires market-based knowledge to provide brokers with tailored employee benefit solutions, including fully insured and self-funded programs across all benefit lines. The duties include cultivating new broker partnerships by generating broker leads, qualifying prospects, and managing our portfolio of products and services. Responsibilities - Build productive, long-lasting relationships by identifying and evaluating broker needs through education, advising, and growing brokers’ revenue with a consultative approach. - Work with brokers to develop insurance solutions that will meet their clients’ needs. - Utilize various methods of communication as primary means of contacting and cultivating relationships to include in-person broker visits, presentations, in addition to phone and online communications. - Leverage company tools and technology (Salesforce, Employee Navigator, Ease, Benefix, Formfire) to enhance broker relationships and drive sales activities. - Create territory/account plans including opportunity development, competitive strategies, and targets. - Identify and create new opportunities and work with sales leaders and cross functional teams to continuously increase prospect funnel. - Understand technology solutions available in the employee benefit marketplace including Benefit Administration systems and underwriting tools. - Track and communicate market trends to/from the field including competitor data and develop effective counter strategies. - Work in a team environment that includes best-in-class back-office support and work to meet annual sales goals and company objectives. - Represent Amwins Connect by attending meetings, events, and training to maintain a competitive advantage. - Consult with brokers and carriers to provide underwriting information to the carrier. - Develop deep relations with Amwins Connect carrier partners. Qualifications - Proven sales experience with group medical or ancillary insurance experience. - Track record of over-achieving goals. - Solutions-oriented mind-set. - Experience working with Salesforce.com or similar CRM, with strong knowledge of various sales techniques and pipeline management. - Current Life & Health insurance license. - Proficient in MS Office software, especially MS Outlook and Excel. - Effective communication, negotiation, and interpersonal skills. - Self-motivated and achievement driven. - Exemplary time management skills. - Firm grasp on ACA and local insurance markets. - Ability to travel for internal conferences and/or training. Core Competencies - Expertise: Develops job knowledge and expertise through continual professional development. Uses technology and reporting to drive sales objectives. - Brand Ambassador: Represents the Amwins Connect brand during all customer and prospect interactions. - Educator: Educates customers on the product, service and solution strategy that will benefit them financially and professionally. - Strategic Focus: Monitors industry competitors, new products, and market conditions. - Team oriented/strong interpersonal skills: Comfortable working with dynamic and diverse customers, and able to handle personalities and situations with a positive can-do attitude. Equal Opportunity Policy The acceptance of the requested information for consideration and referral of candidates will be without regard to a candidate’s race, creed, color, age, gender, marital status, veteran status, national origin, sexual orientation/identification/expression, disability status, or weight and will be based solely on the candidate’s qualifications for the position. We are an equal opportunity employer. Compensation Pursuant to California regulation, the compensation range for this position is as stated and includes eligibility for performance-based bonuses. California Pay Range: $100,000 — $115,000 USD