Lead Director, Stop Loss Relationship Management
Core
Lead enterprise stop loss relationship strategy, governance, and operational performance to manage carrier disputes, funding decisions, and financial risk exposure.
Role type
Senior IC enterprise relationship leader (health insurance/stop loss)
Builds
Enterprise stop loss operating model, governance frameworks, and executive reporting on carrier performance and financial exposure.
Domain
Health insurance / Stop loss management / Financial risk
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Enterprise relationship management, cross-functional program leadership, governance establishment, escalation management, financial risk mitigation, reimbursement performance analysis, executive reporting, process improvement, stakeholder alignment, decision rights definition
Preferred skills
Stop loss and self-funded plan experience, claims operations and underwriting knowledge, high-cost claim management, vendor/partner relationship management, KPI and dashboard development, influence without authority
Technologies
None explicitly stated
Responsibilities
Serve as single point of accountability for stop loss carrier management and escalation resolution; Establish decision rights and governance guardrails for funding and reimbursement issues; Lead cross-functional coordination across operations, finance, claims, legal, and underwriting; Drive improved reimbursement performance by managing aged receivables and high-cost claim escalations; Develop structured carrier management models for consistency and predictability; Partner with senior leaders to assess financial/operational risk and recommend mitigation strategies; Create standardized executive-level reporting on stop loss performance and financial exposure; Identify process gaps and implement scalable solutions to reduce manual work; Lead governance forums and carrier reviews to ensure alignment on priorities and performance.
Seniority
Director, hands-on IC with strategic oversight