Lead Director, Stop Loss Relationship Management
$100,000–$231,540 year
On-siteHartford, Connecticut, United States
Job Summary
Own enterprise stop loss relationship strategy, governance, and operational performance by establishing decision rights, escalation pathways, and guardrails for funding decisions and carrier disputes. Lead cross-functional coordination across operations, finance, claims, legal, and underwriting to resolve high-cost claim issues, aged receivables, and reimbursement delays. Develop a structured carrier management model that improves consistency, predictability, and accountability while identifying root causes of friction and implementing scalable solutions. Partner with senior leaders to assess financial exposure, recommend mitigation strategies, and create executive-level reporting on performance trends and dispute status. Drive alignment on priorities and issue resolution through governance forums and internal stakeholder updates.
Required Qualifications
- 10+ years of experience leading complex business operations, program management, relationship management, healthcare operations, insurance operations, financial risk management, or related functions
- Demonstrated experience managing cross-functional initiatives with senior stakeholders, external partners, and matrixed teams
- Strong ability to establish governance, clarify decision rights, manage escalations, and drive accountability across multiple business areas
- Experience identifying and mitigating operational, financial, legal, compliance, or reimbursement-related risk
- Proven ability to manage complex issue resolution, including disputes, escalations, competing priorities, and time-sensitive business decisions
- Strong financial acumen, including the ability to understand reimbursement performance, receivables, exposure, cost drivers, and operational impacts
- Ability to create executive-level reporting, business cases, decision frameworks, and performance updates
- Excellent communication, influencing, and relationship management skills, with the ability to engage effectively with senior leaders and external partners
- Demonstrated ability to improve processes, implement scalable operating models, and reduce manual or reactive work
- Strong problem-solving, prioritization, and decision-making skills in a fast-paced and complex environment
Desired Qualifications
- Experience with stop loss, self-funded health plans, claims operations, underwriting, medical management, reimbursement, or payer/TPA operations
- Experience managing carrier, vendor, or external partner relationships in a healthcare, insurance, or financial services environment
- Understanding of high-cost claims, funding arrangements, reimbursement processes, audit requirements, and operational risk management
- Experience standing up new governance models, relationship management functions, escalation frameworks, or centralized ownership structures
- Experience working across finance, legal, compliance, operations, claims, account management, underwriting, and executive leadership teams
- Ability to influence without direct authority and drive alignment across stakeholders with differing priorities
- Strong executive presence with the ability to simplify complex issues and recommend practical, business-oriented solutions
- Experience developing KPIs, dashboards, operating routines, and performance management tools
- Bachelor's degree preferred or equivalent combination of education, specialized training, and relevant professional experience
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