Sr. Claims Analyst

Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer stop loss and managed care insurance.

Carbon’s team of experts are known as the industry leader in delivering best-in-class risk solutions to effectively lower healthcare costs. Carbon’s offerings support clients and brokers in a rapidly changing healthcare market with best-in-class service, underwriting, claims support and effective cost containment strategies.

Carbon Stop Loss Solutions is Novacore’s Healthcare Segment. At Novacore, we’re entering an exciting new chapter. Novacore is the newly formed specialty insurance entity created from the April 2025 sale of NSM Insurance Group’s U.S. commercial division. While we carry forward a 35-year legacy of deep industry expertise, we’re transforming what commercial insurance can be. The name Novacore reflects our ambition — nova for new and brilliant, core for strength and purpose. We’re building something bold and meaningful, and every team member plays a vital role in that mission.

With more than $1.3 billion in premium across 15+ specialty insurance programs, we’re transforming the commercial insurance experience — delivering exceptional value to our agent partners and customers through smarter, faster and more collaborative ways of doing business. We specialize in tailored Property & Casualty and Accident & Health insurance solutions for niche industries, powered by advanced analytics, modern technology and a commitment to innovation at every level. Backed by strong leadership and a fresh vision, we’re bringing together the best of our past with bold new ideas to shape the future of specialty insurance.

With a renewed focus, Novacore is positioned to grow and expand through strategic mergers and acquisitions — and to lead the way in the commercial insurance space.

The Sr. Claims Analyst is a healthcare claims professional needed to evaluate and adjudicate reinsurance claims on excess risk and stop loss contracts.

To succeed in this role, the ideal candidate should be analytical, resourceful and self-motivated. The Sr. Claims Analyst should be an excellent communicator, who is willing to speak up and offer ideas and suggestions. Willingness to jump in and independently advance projects and key priorities is welcomed.

• Promote, build and maintain relationships with clients and brokers.
• Receive and interpret claim submissions in a variety of formats.  Perform initial evaluation to ensure submissions are complete.
• Review and fully adjudicate claims according to reinsurance agreements. 
• Validate claims for reimbursement, including application of detailed industry repricing methodologies.
• Provide key reporting metrics to clients.  Respond to inquiries and resolve appeals and pending claims as needed.
• Collaborate on the development and enhancement of Carbon’s proprietary claim adjudication software and systems.  Work closely with developers to maximize efficiency and ensure all claim department needs are met.
• Appropriately escalate difficult issues up the chain of command, as needed.
• Provide outstanding customer service and collaborate with other departments, management, and external partners/leaders.
• Provide guidance and training to team/more Jr. level employees on claim review processes, policy interpretation, and best practices when needed.
• Assist team/managers in quality assurance audits to ensure adherence to company standards.

• Bachelor’s degree, preferred.
• 5+ years’ experience preferably working with medical stop loss claims.
• Proficiency with claim industry pricing methodology including Medicare DRG, RBRVS, transplant contracts and PPO networks.
• Strong Microsoft Office skills, particularly Outlook, Excel and Word.
• Strong written and oral communication skills.
• Skillful at managing multiple priorities and handling interruptions.
• Work independently and as part of a team.
• Can-do attitude is key; eager to jump in and roll up your sleeves.
• Working knowledge of insurance terminology and medical coding.
• Knowledge of the David Young/ESL Claim System.