Lead Director, Stop Loss Relationship Management

This is a fully remote position, open to applicants in Connecticut, +18 more states.

📋 Description

• Act as the primary point of contact and accountability for managing stop loss carriers, addressing escalations, governance, and operational discipline.

• Define decision-making authority, escalation routes, and organizational guidelines for stop loss funding decisions, risk acceptance, reimbursement challenges, and carrier disputes.

• Facilitate cross-departmental collaboration involving operations, finance, claims, legal, underwriting, account management, compliance, and carrier partners.

• Enhance reimbursement performance by overseeing aged receivables, escalations of high-cost claims, documentation requests, audit challenges, and delayed responses from carriers.

• Create and uphold a structured model for carrier management.

• Collaborate with senior leadership to pinpoint financial and operational risks, evaluate exposure, propose mitigation strategies, and aid in decision-making.

• Develop standardized reporting and provide executive insights into stop loss performance, reimbursement delays, dispute trends, escalation status, carrier responsiveness, and financial exposure.

• Identify process deficiencies and underlying causes; implement scalable solutions aimed at reducing manual tasks, enhancing cycle time, and ensuring consistency.

• Lead governance meetings, carrier reviews, and updates for internal stakeholders.

• Convert complex operational, financial, and carrier-related issues into concise executive summaries, recommendations, and decision points.

• Cultivate internal and external relationships to foster accountability, minimize friction, and support sustainable business growth.

• Advocate for ownership, disciplined execution, collaboration, and ongoing improvement.

⛳️ Requirements

• Over 10 years of experience in leading intricate business operations, program management, relationship management, healthcare operations, insurance operations, financial risk management, or similar roles.

• Proven track record in managing cross-functional projects involving senior stakeholders, external partners, and matrixed teams.

• Capability to establish governance, clarify decision-making authority, handle escalations, and ensure accountability across various business domains.

• Experience in identifying and mitigating risks related to operations, finances, legal, compliance, or reimbursement.

• Proficiency in managing complex issue resolution, including disputes, escalations, competing priorities, and urgent business decisions.

• Strong financial insight, encompassing reimbursement performance, receivables, exposure, cost drivers, and operational effects.

• Skill in generating executive-level reports, business cases, decision frameworks, and performance updates.

• Outstanding communication, influence, and relationship management abilities.

• Ability to enhance processes, implement scalable operating models, and decrease manual or reactive tasks.

• Strong problem-solving, prioritization, and decision-making capabilities.

• Bachelor’s degree preferred or an equivalent combination of education, specialized training, and relevant professional experience.

• Preferred: experience with stop loss, self-funded health plans, claims operations, underwriting, medical management, reimbursement, or payer/TPA operations.

• Preferred: experience managing relationships with carriers, vendors, or external partners in healthcare, insurance, or financial services.

• Preferred: knowledge of high-cost claims, funding arrangements, reimbursement processes, audit requirements, and operational risk management.

• Preferred: experience in establishing governance models, relationship management functions, escalation frameworks, or centralized ownership structures.

• Preferred: experience across finance, legal, compliance, operations, claims, account management, underwriting, and executive leadership teams.

• Preferred: ability to influence without direct authority and ensure stakeholder alignment.

• Preferred: strong executive presence and capability to simplify complex issues.

• Preferred: experience in developing KPIs, dashboards, operating routines, and performance management tools.

🏝️ Benefits

• CVS Health bonus, commission or short-term incentive program.

• Award target in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Comprehensive benefits package for eligible colleagues and their families.