Lead Director, Stop Loss Relationship Management

CVS Health

Lead Director at CVS Health accountable for stop loss relationship management and operational performance. Driving strategies, governance, and issue resolution for a more effective health ecosystem.

Posted 7/30/2026full-timeHartford • Connecticut, Ohio, Vermont, Virginia, West Virginia • 🇺🇸 United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in stop loss carrier management, financial risk management, and cross-functional leadership, with a focus on improving operational consistency and accountability. Proficient in creating executive-level reporting and managing complex issue resolution in a fast-paced environment.

Highest-signal resume keywords

Stop Loss Carrier ManagementFinancial Risk ManagementCross-Functional CoordinationGovernance and AccountabilityExecutive-Level Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Program ManagementOperational Risk MitigationReimbursement Performance AnalysisDecision Framework CreationProcess Improvement

Soft Skills

Excellent CommunicationRelationship ManagementProblem-SolvingInfluencing SkillsPrioritization

Industry Keywords

Healthcare OperationsInsurance OperationsComplianceEscalation ManagementStakeholder Engagement

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 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

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
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

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families