Amwins A&H- Claims Manager, Stop Loss

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. 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. 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. As a specialty underwriter, distributor, and program manager, Amwins A&H focuses on medical stop-loss and other accident and health products. Brokers, TPAs and reinsurers rely on the higher standard set by Amwins A&H in everything we do ─ from our thoughtful approach to underwriting to our tenacious focus on delivering superior cost containment, claims administration and customer service.

Our employees pride themselves on prompt, personalized service and our customers have direct access to the claims and underwriting teams. com/opco/amwins-accident-health-underwriters Amwins A&H is an Amwins Group Inc. com ).

1k people.

Benefits

products, and offers value-added services to support some of these products, including product development, underwriting, premium and claims administration and actuarial services. Position Overview 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. The successful candidate will bring deep stop loss claims experience, strong financial and contractual acumen, and the ability to operate effectively in gray areas where precedent, documentation, and interpretation require seasoned judgment.

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.