Director of Claims – Stop-Loss Transformation

S&S Health

Director of Claims & Stop-Loss Transformation at Reflect Health managing claims operations and strategic initiatives. Evaluating current processes and designing future operating models for operational excellence.

Posted 7/11/2026full-timeRemote • Ohio • 🇺🇸 United StatesLead💰 $120,000 - $160,000 per yearWebsite

About the role

Key responsibilities & impact

Lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms.
Assess current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives.
Partner closely with Executive Leadership, Claims Operations, Stop-Loss, Technology, Finance, Compliance, Client Success, and operational teams to evaluate current performance.
Redesign workflows, establish accountability structures, and execute transformation initiatives that enable operational excellence.
Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends.
Conduct structured assessments and develop future-state operating models, transformation strategies, and implementation roadmaps.

Requirements

What you’ll need

Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance organization.
Deep understanding of claims operations, stop-loss administration, employer-sponsored health plans, and healthcare administration workflows.
Experience with self-funded plan mechanics, ASO arrangements, stop-loss contract structures, and carrier relationships preferred.
Knowledge of employer group, broker, TPA, and stop-loss carrier dynamics.
Demonstrated success leading healthcare transformation initiatives, business process redesign, operational modernization, and enterprise change programs.
Experience developing future-state operating models, transformation roadmaps, and scalable operating processes.
Proven ability to identify operational gaps, define improvement opportunities, and drive implementation across organizational boundaries.
Ability to influence executive stakeholders and lead complex initiatives involving multiple business functions.
Experience partnering with Technology teams to implement workflow automation, platform enhancements, data improvements, and operational enablement solutions.
Strong understanding of healthcare administration systems, EDI transactions, claims workflows, and operational processes.
Experience improving claims accuracy, workflow efficiency, operational performance, and service-level outcomes.
Understanding of stop-loss administration processes, including specific and aggregate claims, filing requirements, recoveries, and carrier coordination.
Familiarity with healthcare compliance requirements, including No Surprises Act, ACA reporting, and Continuity of Care requirements preferred.
Strong analytical, strategic thinking, and problem-solving capabilities.
Excellent communication and stakeholder management skills.
Ability to translate complex operational challenges into actionable transformation strategies.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account S&S Health Website LinkedIn All Job Openings 51 - 200 employees Founded 1994 ⚕️ Healthcare Insurance 🤝 B2B ☁️ SaaS Healthcare Insurance
B2B
SaaS S&S Health is a modern health administration provider dedicated to offering affordable healthcare solutions for employers and their employees. By focusing on cost management, S&S Health helps businesses reduce healthcare expenses while maintaining high-quality care. With end-to-end support, they provide tools and resources to ensure that employees have access to the right medical care at competitive prices, ultimately aiming to improve both health outcomes and financial wellbeing. Director of Claims – Stop-Loss Transformation Job not on LinkedIn 🔥 0 minutes ago 🏈 Ohio – Remote 💵 $120k - $160k / year ⏰ Full Time 🔴 Lead 👔 Director Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms.
Assess current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives.
Partner closely with Executive Leadership, Claims Operations, Stop-Loss, Technology, Finance, Compliance, Client Success, and operational teams to evaluate current performance.
Redesign workflows, establish accountability structures, and execute transformation initiatives that enable operational excellence.
Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends.
Conduct structured assessments and develop future-state operating models, transformation strategies, and implementation roadmaps. 🎯 Requirements
Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance organization.
Deep understanding of claims operations, stop-loss administration, employer-sponsored health plans, and healthcare administration workflows.
Experience with self-funded plan mechanics, ASO arrangements, stop-loss contract structures, and carrier relationships preferred.
Knowledge of employer group, broker, TPA, and stop-loss carrier dynamics.
Demonstrated success leading healthcare transformation initiatives, business process redesign, operational modernization, and enterprise change programs.
Experience developing future-state operating models, transformation roadmaps, and scalable operating processes.
Proven ability to identify operational gaps, define improvement opportunities, and drive implementation across organizational boundaries.
Ability to influence executive stakeholders and lead complex initiatives involving multiple business functions.
Experience partnering with Technology teams to implement workflow automation, platform enhancements, data improvements, and operational enablement solutions.
Strong understanding of healthcare administration systems, EDI transactions, claims workflows, and operational processes.
Experience improving claims accuracy, workflow efficiency, operational performance, and service-level outcomes.
Understanding of stop-loss administration processes, including specific and aggregate claims, filing requirements, recoveries, and carrier coordination.
Familiarity with healthcare compliance requirements, including No Surprises Act, ACA reporting, and Continuity of Care requirements preferred.
Strong analytical, strategic thinking, and problem-solving capabilities.
Excellent communication and stakeholder management skills.
Ability to translate complex operational challenges into actionable transformation strategies. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Executive Business Director 🔥 1 hour ago DBV Technologies 51 - 200 🧬 Biotechnology 💊 Pharmaceuticals Website LinkedIn All Job Openings Executive Business Director responsible for the launch and growth of Viaskin® platform across multiple states. Leading sales team to achieve objectives while ensuring compliance and market shaping. 🇺🇸 United States – Remote 💵 $260k - $325k / year 🔥 Funding within the last year 💰 $30M Post-IPO Secondary - DBV Technologies on 2025-10 ⏰ Full Time 🔴 Lead 👔 Director Director 🔥 4 hours ago Freebird 11 - 50 💄 Beauty 🛒 Retail 🔧 Hardware Website LinkedIn All Job Openings Director of Amazon managing strategy and operations for Freebird®, a high-growth DTC brand. Focused on profitability and operational excellence in the Amazon marketplace. 🇺🇸 United States – Remote ⏰ Full Time 🔴 Lead 👔 Director Product Director 🔥 6 hours ago Vericast 5001 - 10000 💸 Finance 💳 Fintech ☁️ SaaS Website LinkedIn All Job Openings Product Director at Vericast overseeing product development lifecycle for financial institutions. Collaborating with cross-functional teams to drive product innovation and execution strategies. 🇺🇸 United States – Remote 💵 $165k - $185k / year ⏰ Full Time 🔴 Lead 👔 Director Product Director – Digital Channels 🔥 6 hours ago Vericast 5001 - 10000 💸 Finance 💳 Fintech ☁️ SaaS Website LinkedIn All Job Openings Product Director managing Digital Channels portfolio at Vericast. Involved in strategy, planning, and project leadership for financial institutions' growth and efficiency. 🇺🇸 United States – Remote 💵 $165k - $170k / year ⏰ Full Time 🔴 Lead 👔 Director Director – Commercial Channel 🔥 9 hours ago Johnson & Johnson 10,000+ employees ⚕️ Healthcare Insurance 💊 Pharmaceuticals 🧬 Biotechnology Website LinkedIn All Job Openings Director - Commercial Channel leading strategic growth across key distributor partners and executing joint business plans for JJMT Surgery. Collaborating with cross-functional teams to expand demand and adoption. 🇺🇸 United States – Remote 💵 $150k - $258.8k / year ⏰ Full Time 🔴 Lead 👔 Director 🦅 H1B Visa Sponsor View More Director Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

Claims OperationsStop-Loss AdministrationBusiness Process RedesignOperational ModernizationTransformation RoadmapsHealthcare Administration SystemsEDI TransactionsOperational Performance ImprovementData ImprovementsService-Level Outcomes

Soft Skills

Analytical SkillsStrategic ThinkingProblem-SolvingCommunication SkillsStakeholder Management