Stop Loss Claims Analyst

Job Listing ID:

4440304

Job Title:

Stop Loss Claims Analyst Application Deadline:

03/25/2026

Job Location:

Medford

Date Posted:

02/23/2026

Hours Worked Per Week:

40

Shift:

Day Shift Duration of Job:

Full Time, more than 6 months You may contact this employer directly. (Obtain the contact information to print or add to your jobs.)

Job Summary:

Stop Loss Claims Analysts Work from home within Oregon, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Stop Loss Claims Analysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to

Cambia:

Qualifications:

Stop Loss Claims Analyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience.

Skills and Attributes:

• Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim.
• Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements.
• Advanced knowledge of claim reserving and settlement.
• Excellent communication skills for both external and internal customers
• Demonstrate understanding of medical terminology and

ICD-10/CPT

coding.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do at

Cambia:

• Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details.
• Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information.
• Lead the process to measure, track, and report all aggregate claims.
• Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed.
• Manage inventory of claims while ensuring best practices and claim standards are met.
• Identify new opportunities to track and process claims more efficiently.

Thoroughly document claims throughout the adjudication process To view the full job description please use the link below. https://www.aplitrak.com/?adid=YmJnZW5lcmljLjA5MTEzLjg3NjRAY2FtYmlhaGVhbHRoY29tcC5hcGxpdHJhay5jb20

Job Classification:

Claims Adjusters, Examiners, and Investigators Access our statewide or regional occupation report for more information about wages, employment outlooks, skills, training programs, related occupations, and more. Compensation

Salary:

Depending on Experience Job Requirements

Experience Required:

 At least 1 year

Education Required:

None

Minimum Age:

N/A Gender:

N/A