Compare your current skills to what this opportunity needs—we'll show you what you already have and what could strengthen your application.
Job Description
Job Classification:
Operations - Insurance Operations 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.
Key Responsibilities:
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:
Required Experience 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. Technical Expertise 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. Leadership Characteristics 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. Education Bachelor's degree in Business, Healthcare Administration, or a related field preferred.
What we offer you:
Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $106,000.00 to $174,900.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills. 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, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week. Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom. Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law. If you need an accommodation to complete the application process, please email accommodations.hw@prudential.com. If you are experiencing a technical issue with your application or an assessment, please email careers.technicalsupport@prudential.com to request assistance. Prudential Financial, Inc. (
NYSE:
PRU), a global financial services leader and premier active global investment manager with approximately $1.4 trillion in assets under management as of Dec. 31, 2023, has operations in the United States, Asia, Europe, and Latin America. Prudential's diverse and talented employees help make lives better and create financial opportunity for more people by expanding access to investing, insurance, and retirement security. Prudential's iconic Rock symbol has stood for strength, stability, expertise and innovation for 150 years. For more information please visit news.prudential.com. Our Commitment to an Inclusive Workplace Prudential Financial, Inc. serves its customers in more than 40 countries and territories, and we seek talented, creative individuals from a variety of backgrounds, worldviews, and life circumstances to work with us. We are focused on creating a fully inclusive culture, where all employees feel comfortable bringing their authentic selves to work. We don't just accept difference—we celebrate it, support it, and thrive on it. At Prudential, employees have a unique opportunity to build their career path by owning their development, their career, and their future. We encourage employees to hone their skills and explore continued opportunities within Prudential. PGIM, the global asset management business of Prudential Financial, Inc. (
NYSE:
PRU), is a global investment manager with US $1.3 trillion in assets under management as of Dec. 31, 2023. With offices in 18 countries, PGIM's businesses offer a range of investment solutions for retail and institutional investors around the world across a broad range of asset classes, including public fixed income, private fixed income, fundamental equity, quantitative equity, real estate, and alternatives. For more information about PGIM, visit pgim.com. Prudential Financial, Inc. (PFI) of the United States is not affiliated in any manner with Prudential plc, incorporated in the United Kingdom, or with Prudential Assurance Company, a subsidiary of M&G plc, incorporated in the United Kingdom. For more information please visit news.prudential.com. PGIM Inc. (PGIM) is the principal asset management business of Prudential Financial, Inc. (PFI), a company incorporated and with its principal place of business in the United States. PFI of the United States is not affiliated in any manner with Prudential plc, incorporated in the United Kingdom or with Prudential Assurance Company, a subsidiary of M&G plc, incorporated in the United Kingdom. Our Commitment to an Inclusive Workplace Prudential Financial, Inc. serves its customers in more than 40 countries and territories, and we seek talented, creative individuals from a variety of backgrounds, worldviews, and life circumstances to work with us. We are focused on creating a fully inclusive culture, where all employees feel comfortable bringing their authentic selves to work. We don't just accept difference—we celebrate it, support it, and thrive on it. At Prudential, employees have a unique opportunity to build their career path by owning their development, their career, and their future. We encourage employees to hone their skills and explore continued opportunities within Prudential.
