Senior Manager, Stop Loss Filling

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the Stop-Loss Operations function, encompassing policy establishment, accuracy in filing, management of lasers and disclosures, renewals, and claims reimbursement submissions.

• Unify stop-loss sub-teams that currently operate on various legacy platforms, workflows, and quality standards into a single operational model.

• Create and implement controls to achieve zero processing errors while ensuring compliance with carrier, regulatory, and contractual obligations.

• Establish standardized SOPs, quality-audit processes, error tracking mechanisms, root-cause analysis, and corrective actions.

• Supervise and mentor stop-loss team leads and staff, focusing on performance management, capacity planning, and career advancement.

• Collaborate with Account Management, Sales, Client Services, carriers, and MGUs regarding stop-loss issues, filings, coverage inquiries, escalations, renewals, and resolutions.

• Develop and present KPIs and SLAs to executive management.

• Assist in platform migration, particularly the transition from QicLink to VBA, for stop-loss data, workflows, and system configuration.

• Recognize larger operational process gaps and advocate for a systems-over-silos methodology.

⛳️ Requirements

• Minimum of 7 years of progressive stop-loss experience within a TPA, carrier, MGU, or reinsurer, including direct oversight of a stop-loss operations team.

• Established connections with stop-loss carriers and MGUs, covering areas such as carrier communications, filings, escalations, renewals, and dispute resolution.

• Proven track record of successfully integrating or consolidating teams operating on different legacy systems, workflows, or standards.

• Extensive understanding of specific and aggregate stop-loss coverage, lasers, disclosure requirements, run-in/run-out scenarios, and claims reimbursement procedures.

• Experience in developing or revamping processes aimed at reducing error rates to zero and ensuring full compliance.

• Strong ability to foster cross-functional partnerships, along with credibility and communication skills.

• Capability to thrive in a dynamic, private-equity-backed environment undergoing platform migrations and acquisitions.

• Familiarity with QicLink, VBA, or similar TPA core administration platforms is highly preferred.

• Experience with Ringmaster or similar TPA stop-loss filing software is strongly preferred.

• Exceptional written and verbal communication abilities, including the skill to translate operational details into executive summaries.

🏝️ Benefits

• Comprehensive medical, dental, vision, and life insurance coverage.

• 401(k) retirement plan with employer matching contributions.

• Health Savings Account (HSA) and Flexible Spending Accounts (FSAs).

• Paid time off (PTO) along with disability leave.

• Employee Assistance Program (EAP).

• Potential for bonuses and merit increases for eligible positions.