Lead Director, Stop Loss Relationship Management

CVS Health

. Serve as the dedicated relationship owner and single point of accountability for stop loss carrier management, escalation resolution, governance, and operating discipline .

Posted 9/22/2026full-timeRemote • United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex business operations and financial risk management, with a strong focus on relationship management and governance in healthcare and insurance sectors. Capable of creating executive-level reporting and implementing scalable operating models to enhance performance and accountability.

Highest-signal resume keywords

10+ Years Experience In Business OperationsFinancial Risk ManagementGovernance And Decision Rights EstablishmentCross-Functional Initiative ManagementExecutive-Level Reporting Creation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Program ManagementReimbursement Performance ManagementOperational Risk ManagementClaims OperationsDecision Framework DevelopmentKPI DevelopmentAudit Requirements UnderstandingEscalation ManagementProcess ImprovementFinancial Acumen

Soft Skills

Excellent Communication SkillsRelationship ManagementProblem-Solving SkillsInfluencing SkillsCollaboration

Industry Keywords

Stop LossSelf-Funded Health PlansHealthcare OperationsInsurance OperationsPayer/TPA OperationsVendor ManagementHigh-Cost ClaimsFunding ArrangementsOperational ImpactsMatrixed Teams

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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