Stop Loss Claims Analyst

Stop Loss Claims Analyst at Cambia Health Solutions

We invite you to apply for the Stop Loss Claims Analyst role, working from home within Oregon, Washington, Idaho, or Utah. This position supports our mission to create a person‑focused and economically sustainable health care system by adjudicating all stop loss claims and ensuring consistent claim practices in line with policy, contract terms, and applicable laws and regulations.

• High School Diploma or GED with at least 5 years of professional claims processing experience, or an equivalent combination of education and experience.
• Strong communication skills for both external and internal customers.
• Knowledge of legal and clinical resources to interpret medical terminology and make determinations on claims.
• Proficiency with policy and contract terms, deductibles, and eligibility to process eligible claim reimbursements accurately.
• Advanced understanding of claim reserving and settlement.
• Experience with AI tools and technologies to enhance productivity and decision‑making (highly desired).
• Understanding of medical terminology and ICD‑10/CPT coding.

• Accurately apply contract benefits, recognize incomplete or inappropriate claims, and reference relevant documentation.
• Make informed decisions on claim disposition, including payment, denial, or requests for further information.
• Lead processes to measure, track, and report aggregate claims.
• Audit aggregate claims onsite and off‑site as needed, providing audit reporting to clients.
• Manage claim inventory while ensuring best practices and standards are met.
• Identify opportunities to improve claim processing efficiency, documenting decisions for audit purposes.
• Analyze and investigate all claims, requesting supplementary documentation to expedite accurate processing.

• No unusual working conditions.
• Primarily performed in an office environment.

The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 – $93,150.00, depending on skills, experience, education, and location. A 10% bonus target is available.

Cambia is a purpose‑driven, award‑winning organization built on trust and innovation, anchored in a 100+ year history. We embrace collaboration, community outreach, and continuous learning, fostering a culture where employees grow and thrive while making a difference in members’ lives.

• Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.
• Annual employer contribution to a Health Savings Account.
• Generous paid time off, including 10 company‑paid holidays.
• Market‑leading 401(k) with company match and potential discretionary contributions.
• Up to 12 weeks of paid parental leave (eligible after 12 months continuous service).
• Award‑winning wellness programs and Employee Assistance Fund.
• Commute and parking benefits.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, veteran status, or other protected status. A background check is required.

To apply, email your resume to C We welcome accommodations during the application process. Please refer to our Privacy Policy for information on how we collect, use, and disclose your information.