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About the Role

The Lead Director, Stop Loss Relationship Management will serve as the single accountable owner for enterprise stop loss relationship strategy, governance, escalation management, and operational performance. This role is responsible for creating a more disciplined, scalable, and consistent operating model across stop loss carriers, internal business partners, and cross-functional stakeholders.

Responsibilities

• Serve as the dedicated relationship owner and single point of accountability for stop loss carrier management, escalation resolution, governance, and operating discipline.
• Establish clear decision rights, escalation pathways, and enterprise guardrails for stop loss-related funding decisions, risk acceptance, reimbursement issues, and carrier disputes.
• Lead cross-functional coordination across operations, finance, claims, legal, underwriting, account management, compliance, and carrier partners to ensure consistent execution and timely resolution of stop loss issues.
• Drive improved reimbursement performance by proactively managing aged receivables, high-cost claim escalations, documentation requests, audit friction, and delayed carrier responses.
• Develop and maintain a structured carrier management model that improves consistency, leverage, predictability, and accountability across a fragmented stop loss carrier ecosystem.
• Partner with senior leaders to identify financial and operational risk, assess exposure, recommend mitigation strategies, and support timely decision-making.
• Create standardized reporting and executive-level visibility into stop loss performance, including reimbursement delays, dispute trends, escalation status, carrier responsiveness, and financial exposure.
• Identify process gaps, root causes, and recurring friction points; implement scalable solutions that reduce manual work, improve cycle time, and increase operational consistency.
• Lead governance forums, carrier reviews, and internal stakeholder updates to ensure alignment on priorities, performance expectations, and issue resolution.
• Translate complex operational, financial, and carrier issues into clear executive-ready summaries, recommendations, and decision points.
• Build strong internal and external relationships to improve accountability, reduce friction, and support long-term business growth.
• Promote a culture of ownership, disciplined execution, collaboration, and continuous improvement.

Requirements

• 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.

Skills

• Stop loss
• Self-funded health plans
• Claims operations
• Underwriting
• Medical management
• Reimbursement
• Payer/TPA operations
• Carrier management
• Vendor management
• External partner relationships
• Healthcare
• Insurance
• Financial services
• High-cost claims
• Funding arrangements
• Audit requirements
• Operational risk management
• Governance models
• Relationship management functions
• Escalation frameworks
• Centralized ownership structures
• Finance
• Legal
• Compliance
• Operations
• Claims
• Account management
• Executive leadership
• KPI development
• Dashboard creation
• Operating routines
• Performance management tools

Work Type

• Full-time

Experience Level

• Lead Director

Education Level

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

Salary/Compensations

• $100,000.00 - $231,540.00

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs

About the Company

• We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.
• At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
• Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Equal Opportunity

• Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.