Prudential is one of the world’s largest financial and insurance services companies. The employer offers eligible employees a comprehensive benefits package t
Head of Stop Loss Claims
Location
United States
Posted
15 days ago
Salary
$106K - $174.9K / year
Seniority
Lead
No structured requirement data.
Job Description
Head of Stop Loss Claims
Prudential
Role Description Help Lead the Future of Medical Stop Loss Claims at Prudential. Prudential is continuing to grow and expand its capabilities as a premier medical stop loss carrier. As part of this exciting evolution, we are seeking a Head of Stop Loss Claims to build and lead our claims organization. This is a unique opportunity for a hands-on leader who thrives in high-growth environments and is energized by creating processes, developing talent, and shaping the future of a business. You'll play a critical role in designing our claims operations, driving innovation, and ensuring an exceptional experience for our customers, brokers, consultants, and partners. - Strategic Leadership: - Develop and execute the vision, strategy, and operating model for Prudential's Stop Loss Claims function. - Establish scalable workflows, governance, and best practices that support continued growth and operational excellence. - Claims System Development: - Partner in the design, implementation, and optimization of claims technology solutions. - Provide subject matter expertise to ensure efficient workflows and industry-leading claims practices. - Team Building & Leadership: - Recruit, develop, and lead a high-performing claims organization. - Foster a culture of accountability, collaboration, continuous improvement, and professional development. - Claims Oversight: - Review and approve high-dollar and complex medical stop loss claims. - Ensure consistent, accurate claim adjudication aligned with policy provisions, contractual obligations, and company standards. - Stakeholder Management: - Serve as the primary claims leader and ambassador for Prudential's Medical Stop Loss business. - Build strong relationships with brokers, TPAs, reinsurers, vendors, consultants, and internal partners. - Operational Excellence & Innovation: - Leverage data, analytics, and technology to improve accuracy, efficiency, and service delivery. - Drive process improvements that reduce cycle times and enhance the customer experience. - Regulatory Compliance: - Ensure adherence to all applicable federal and state regulations, contractual requirements, and internal controls. - Cross-Functional Partnership: - Collaborate across underwriting, implementation, account management, finance, actuarial, and operations teams to deliver seamless end-to-end service. Qualifications - 10+ years of experience in group insurance claims including some meaningful experience supporting medical stop loss claims operations. - Deep knowledge of stop loss claim adjudication, reimbursement methodologies, policy interpretation, and industry best practices. - Proven experience leading teams and driving operational transformation in a growing organization. - Strong understanding of medical terminology, CPT/HCPCS/ICD-10 coding, stop loss policy language, and claims workflows. - Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, and Outlook. - Builder mindset with the ability to create structure in a growing business. - Strong executive presence, communication skills, and stakeholder management capabilities. - Demonstrated success leading through change, influencing across functions, and developing talent. - Bachelor's degree in Business, Healthcare Administration, or a related field preferred. Requirements - Salary range for this role is from $106,000.00 to $174,900.00, varying based on geographic location, candidate experience, and skills. Benefits - Market competitive base salaries, with a yearly bonus potential at every level. - Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave. - 401(k) plan with company match (up to 4%). - Company-funded pension plan. - Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs. - Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development. - Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs. - Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period). - Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program.
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