Director of Claims & Stop-Loss Transformation - REMOTE

We need to output HTML fragment with sections: headings

for each section that has content. Use

• for lists. Use

  for prose. No job title heading. No Job ID etc. Remove boilerplate: "Reflect Health is committed to providing a safe and secure workplace..." etc. Also remove "All final candidates will be subject to background checks..." etc. Also remove any duplicated lines. Keep all substantive info. We need to parse the posting. Let's extract sections: - About the role? Actually the first paragraph is description of company and role overview. Could be "About the role" or maybe "Overview". The instruction says use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We should map content accordingly. We have: Company description: "Reflect Health is the evolution of S&S Health...". That's about the company. Could be under "About the role" or maybe not needed. But we need to include substantive info. The instruction: "include a section ONLY when the posting has real, specific content for it". So we can have "About the role" with that description. Then responsibilities: many bullet-like paragraphs under "Responsibilities". The posting lists sections: "Transformation Strategy & Future-State Design", "Business Process Transformation", "Claims & Stop-Loss Modernization", "Technology Enablement & Automation", "Transformation Governance & Measurement", "Change Management & Stakeholder Alignment". Those are subheadings within responsibilities. We could treat each as a subsection under Responsibilities? But we only allowed headings like Responsibilities (h3) and then list items. However we could embed subheadings as

  ? Not allowed? The instruction only mentions using

  for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but says use

  for section headings (list). Probably we should stick to those headings only. So we need to consolidate responsibilities into a list under

  Responsibilities

  . Each responsibility item can be a
• . We need to preserve all substantive information; we can break down each bullet into list items. Similarly Qualifications: there are subheadings: Industry Experience, Transformation Leadership, Process & Technology Expertise, Claims & Stop-Loss Expertise, Leadership & Communication. We'll put them under

  Qualifications

  as list items. Skills? Not explicitly separate; maybe included in Qualifications. We could omit Skills section if no specific content. Benefits, Pay, Schedule: not present, so omit. We also need to include maybe "Requirements" vs "Qualifications". The posting has "Qualifications". We'll use that. We need to preserve all substantive info: company description, responsibilities details, qualifications details. We must not include boilerplate: "Reflect Health is committed to providing a safe and secure workplace..." and background check line. Also remove any duplicated lines. Let's extract responsibilities text: From posting: "Responsibilities Transformation Strategy & Future-State Design Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends. Conduct structured assessments to identify operational gaps, root causes, scalability challenges, and improvement opportunities. Develop future-state operating models, transformation strategies, and implementation roadmaps aligned with Reflect Health’s long-term growth objectives. Establish transformation priorities, milestones, implementation plans, and success measures. Provide executive leadership with strategic recommendations, business cases, and investment priorities for transformation initiatives. Establish baseline KPIs, operating cadences, and accountability structures to measure transformation progress. Business Process Transformation Lead enterprise process redesign initiatives focused on simplifying workflows, reducing administrative complexity, improving operational scalability, and enhancing service performance. Conduct process assessments, workflow analysis, process mapping, and root-cause evaluations to identify improvement opportunities. Establish transformation priorities, milestones, and implementation plans. Redesign workflows and operating models to improve efficiency, quality, and consistency, as well as the development of standardized procedures, governance models, and operational accountability structures. Facilitate cross-functional design sessions to develop sustainable future-state processes. Claims & Stop-Loss Modernization Lead modernization efforts across claims and stop-loss administration, including specific and aggregate claim processes, reporting workflows, filing timelines, and recovery processes Evaluate end-to-end claims workflows, including intake, adjudication, payment, quality processes, and exception management, to identify opportunities for improvement. Identify opportunities to reduce claims errors, rework, pend volume, manual intervention, and service-level misses. Support initiatives that improve claims effectiveness, operational consistency, automation, and organizational readiness. Partner with Operations leaders to improve claims quality frameworks, root-cause feedback loops, and continuous improvement practices. Assess opportunities to improve plan configuration discipline, auto-adjudication rates, eligibility administration, and EDI processes. Support automation opportunities for high-dollar claim identification, filing triggers, and exception management. Technology Enablement & Automation Partner with Technology teams to translate business opportunities into system enhancements, automation opportunities, platform improvements, and data-driven solutions. Support evaluation of technology capabilities and recommend enhancements that enable future-state operations. Identify opportunities for workflow automation, TPA platform optimization, EDI improvements, and operational enablement solutions. Drive alignment between business strategy, operational needs, and technology investments. Support development of operational dashboards and reporting capabilities that improve leadership visibility into performance trends, risks, and opportunities. Transformation Governance & Measurement Establish transformation governance frameworks, initiative tracking, executive reporting, and benefit realization processes. Define transformation success measures related to claims performance, operational efficiency, stop-loss effectiveness, automation adoption, and service improvements. Develop executive-level dashboards and communications related to transformation initiatives. Provide leadership visibility into progress, risks, dependencies, and outcomes. Change Management & Stakeholder Alignment Lead organizational change efforts required to successfully implement new processes, technologies, and operating models. Build alignment among teams, and facilitate communication, adoption planning, and organizational readiness activities. Partner with operational leaders to ensure redesigned processes are successfully implemented and sustained." We need to convert each bullet into list items. Could group under each subheading as separate
• but we can also keep subheadings as inside
• ? The instruction only says use
  • for any list of duties/requirements/benefits. It doesn't forbid adding headings inside list items. But to keep simple, we can make each bullet a
  • . However we might lose the subheading grouping. But it's okay as long as we preserve all info. We could also make each subheading a

    inside the responsibilities section, but not required. Safer to just list. Similarly qualifications: "Qualifications Industry Experience 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. Transformation Leadership 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. Process & Technology Expertise 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 leveraging operational data, reporting tools, and analytics to identify root causes and support business decisions. Familiarity with claims technology platforms, workflow tools, automation solutions, and operational reporting capabilities. Claims & Stop-Loss Expertise 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. Leadership & Communication Strong analytical, strategic thinking, and problem-solving capabilities. Excellent communication and stakeholder management skills. Ability to translate complex operational challenges into actionable transformation strategies. Ability to operate effectively in environments requiring cross-functional influence, organizational change, and continuous improvement." We'll convert each sentence to

    . Now company description paragraph: "Reflect Health is the evolution of S&S Health, a trusted independent third-party administrator founded in 1994 to meet the growing need for access, simplified connectivity, and benefits administration. Headquartered in Mason, OH, we have built a reputation based on innovation, service excellence, and a deep understanding of how to drive better outcomes at lower cost. Over the years, we grew into a national presence serving employers, TPAs, health systems, and benefit consultants across all 50 states. We developed proprietary claims technology, expanded our offerings to include level-funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members. We are seeking a Director of Claims & Stop-Loss Transformation to lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms. Reporting to the Chief of Staff, Transformation Office, this role serves as a transformation leader responsible for assessing current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives that improve scalability, efficiency, quality, and organizational performance. This role will 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. The ideal candidate is an experienced healthcare transformation with expertise in self-funded health plan administration, claims operations, stop-loss administration, business process redesign, technology enablement, operational analytics, and organizational change management. This individual must be comfortable operating as both a strategic transformation leader and a hands-on operator capable of driving measurable improvements across core TPA functions." We can put that under

    About the role

    as

    . Now we need to output only HTML fragment. Let's craft:

    About the role

    ... (the paragraph)

    Responsibilities

    • Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends.
    • Conduct structured assessments to identify operational gaps, root causes, scalability challenges, and improvement opportunities.
    • Develop future-state operating models, transformation strategies, and implementation roadmaps aligned with Reflect Health’s long-term growth objectives.
    • Establish transformation priorities, milestones, implementation plans, and success measures.
    • Provide executive leadership with strategic recommendations, business cases, and investment priorities for transformation initiatives.
    • Establish baseline KPIs, operating cadences, and accountability structures to measure transformation progress.
    • Lead enterprise process redesign initiatives focused on simplifying workflows, reducing administrative complexity, improving operational scalability, and enhancing service performance.
    • Conduct process assessments, workflow analysis, process mapping, and root-cause evaluations to identify improvement opportunities.
    • Establish transformation priorities, milestones, and implementation plans.
    • Redesign workflows and operating models to improve efficiency, quality, and consistency, as well as the development of standardized procedures, governance models, and operational accountability structures.
    • Facilitate cross-functional design sessions to develop sustainable future-state processes.
    • Lead modernization efforts across claims and stop-loss administration, including specific and aggregate claim processes, reporting workflows, filing timelines, and recovery processes.
    • Evaluate end-to-end claims workflows, including intake, adjudication, payment, quality processes, and exception management, to identify opportunities for improvement