Sr. Manager of Stop Loss
Responsibilities
Define and execute the Stop Loss operating model: Set the long-term vision, strategy, and structure for the function — translating corporate priorities into departmental goals and ensuring every team is aligned and accountable.
Drive financial performance and reimbursement outcomes: Own the results across claim filings, reimbursement recovery, and cash flow management, with a relentless focus on eliminating financial leakage and optimizing recovery.
Lead enterprise transformation initiatives: Sponsor and direct large-scale system implementations, automation strategies, and workflow redesigns that modernize operations and position the function for sustainable growth.
Oversee the full claim lifecycle at a strategic level: Ensure accuracy, compliance, and maximized reimbursement across specific and aggregate claims — with direct involvement in high-risk, complex, and escalated situations and carrier negotiations.
Build and evolve data and analytics capabilities: Oversee reporting strategies and advanced analytics that surface actionable insights on claims performance, reimbursement trends, and financial forecasting — and ensure data integrity across all systems.
Establish governance, compliance, and risk controls: Develop and maintain audit frameworks, compliance processes, and governance structures that keep the function aligned with regulatory requirements, contractual obligations, and internal policy.
Partner cross-functionally at the executive level: Influence enterprise decisions across Finance, Underwriting, Claims, Client Services, Compliance, and IT — and represent Stop Loss in steering committees, executive forums, and strategic planning discussions.
Lead and develop a multi-level leadership team: Build leadership capability, drive succession planning, and coach managers and supervisors on performance management, change leadership, and operational excellence.
Shape external partnerships and carrier relationships: Build and negotiate strategic relationships with TPAs, carriers, and vendors to drive service excellence and favorable financial outcomes.
Lead enterprise-wide strategic initiatives: Drive M&A integrations, new product implementations, process standardization, and change management efforts that expand organizational capability and deliver measurable business impact.
Qualifications
Bachelor's degree in Finance, Healthcare Administration, Business, or a related field required; Master's degree preferred 10+ years of Stop Loss, TPA, or healthcare claims experience with deep expertise in reimbursement strategy and claims adjudication 5–7+ years of progressive leadership experience, including managing managers and leading large or complex teams
Demonstrated success leading enterprise-level transformation initiatives and scaling operations
Expert-level knowledge of stop loss operations, claims management, and reimbursement processes
Strong understanding of medical terminology and coding (ICD-10, CPT, HCPCS)
Advanced financial acumen including budgeting, forecasting, and revenue optimization
Advanced proficiency in Microsoft Excel and analytics tools; experience with data visualization platforms and database management systems preferred
Familiarity with Lean, Six Sigma, or comparable continuous improvement methodologies
Knowledge of stop loss contract structures, financial modeling, and risk management principles
Benefits
The Highlights:
- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Unlimited PTO—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
Compensation: This position offers a base salary range of $107,000 - $140,000, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.