Lead Director, Stop Loss Relationship Management

Job not on LinkedIn

🔥 17 hours ago

🦌 Connecticut, Florida, +17 more states – Remote

🦌 Connecticut – Remote 🐊 Florida – Remote 🐎 Kentucky – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👔 Director

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Serve as the dedicated relationship owner and single point of accountability for stop loss carrier management, escalation resolution, governance, and operating discipline • Establish decision rights, escalation pathways, and enterprise guardrails for stop loss 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 • Improve reimbursement performance by managing aged receivables, high-cost claim escalations, documentation requests, audit friction, and delayed carrier responses • Develop and maintain a structured carrier management model • Partner with senior leaders to identify financial and operational risk, assess exposure, recommend mitigation strategies, and support decision-making • Create standardized reporting and executive visibility into stop loss performance, reimbursement delays, dispute trends, escalation status, carrier responsiveness, and financial exposure • Identify process gaps and root causes; implement scalable solutions to reduce manual work, improve cycle time, and increase consistency • Lead governance forums, carrier reviews, and internal stakeholder updates • Translate complex operational, financial, and carrier issues into executive-ready summaries, recommendations, and decision points • Build internal and external relationships to improve accountability, reduce friction, and support long-term business growth • Promote 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 • Experience managing cross-functional initiatives with senior stakeholders, external partners, and matrixed teams • 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 • Ability to manage complex issue resolution, including disputes, escalations, competing priorities, and time-sensitive business decisions • Strong financial acumen, including 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 • Ability to improve processes, implement scalable operating models, and reduce manual or reactive work • Strong problem-solving, prioritization, and decision-making skills • Bachelor’s degree preferred or 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 carrier, vendor, or external partner relationships in healthcare, insurance, or financial services • Preferred: understanding of high-cost claims, funding arrangements, reimbursement processes, audit requirements, and operational risk management • Preferred: experience 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 drive stakeholder alignment • Preferred: strong executive presence and ability to simplify complex issues • Preferred: experience 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 • Other resources supporting physical, emotional, and financial well-being • Comprehensive benefits package for eligible colleagues and their families