Senior Manager of Stop-Loss Operations

The Sr. Manager of Stop-Loss Operations is responsible for building and leading the stop-loss function that underpins Point C's self-funded health plan business, ensuring accuracy, compliance, and consistency across a growing and increasingly complex book of business. This role serves as the operational backbone for stop-loss, acting as a trusted expert and change agent who unifies teams, systems, and processes inherited through growth and acquisition. The Sr. Manager oversees all aspects of stop-loss operations, from policy setup and filings through renewals and claims reimbursement, ensuring zero-error execution and a seamless experience for Account Management and clients alike.

Job Responsibilities

• End-to-end leadership of the Stop-Loss Operations function, including policy setup, filing accuracy, laser and disclosure management, renewals, and claims reimbursement submissions.
• Integration of multiple stop-loss sub-teams — including those inherited through acquisition — that currently operate on different legacy platforms, workflows, and quality standards, into a single, consistent operating model.
• Design and enforcement of controls that drive the team toward zero processing errors and full compliance with carrier, regulatory, and contractual requirements.
• Development of standardized SOPs, quality-audit routines, and error-tracking mechanisms, with clear root-cause and corrective-action discipline.
• Direct oversight and coaching of stop-loss team leads and staff, including performance management, capacity planning, and career development.
• Serving as the primary operational partner to Account Management, Sales, and Client Services on all stop-loss matters — filings, coverage questions, escalations, and renewal readiness — protecting the client experience even when the underlying issue is internal.
• Partnership with carriers and MGUs on policy terms, filing requirements, timeliness standards, and issue resolution.
• Building and reporting KPIs and SLAs (filing timeliness, error rates, reimbursement turnaround, audit results) to executive leadership.
• Supporting platform migration work (including QicLink-to-VBA transition) as it relates to stop-loss data, workflows, and system configuration.
• Acting as a change agent across the broader Operations organization — identifying process gaps beyond stop-loss and championing a "systems over silos" approach to how teams work together.

Qualifications

• 7+ years of progressive stop-loss experience at a TPA, carrier, MGU, or reinsurer, including direct management of a stop-loss operations team.
• Established rapport and working relationships with stop-loss carriers and MGUs, with a track record of managing day-to-day carrier communication, filings, and escalations, and maintaining credibility through renewals and disputes.
• Demonstrated success integrating or consolidating teams that operated on different legacy systems, workflows, or standards — you can point to a specific before-and-after.
• Deep working knowledge of stop-loss policy mechanics: specific and aggregate coverage, lasers, disclosure requirements, run-in/run-out, and claims reimbursement processes.
• A track record of building or overhauling processes to drive error rates toward zero and sustain full compliance — not just identifying problems, but fixing them permanently.
• Strong cross-functional partnership skills, with the credibility and communication style to work closely with Account Management and other client-facing teams without becoming purely reactive to them.
• Comfort operating in a fast-moving, private-equity-backed environment undergoing platform migration and acquisition integration.
• Experience with QicLink, VBA, or comparable TPA core administration platforms strongly preferred.
• Experience with Ringmaster or a comparable TPA stop-loss filing software strongly preferred.
• Excellent written and verbal communication skills, including the ability to translate operational detail into clear updates for executive leadership.

Pay Transparency 80000 - 90000 USD