What you'll do

The Senior Director, Stop Loss & Funding Operationsleads the end-to-end operational administration of medical stop-loss coverage, client claim funding, and premium funding for the organization's self-funded clients. This leader has direct people-leadership accountability for assigned employees and provides functional leadership to an extended team of cross-functional partners who contribute to stop-loss and funding outcomes.

In this role, you'll also:

Lead the end-to-end administration of stop-loss programs, including implementation, policy administration, reimbursement management, renewals, run-out, and terminations.
Ensure operational processes, policies, systems, and controls are aligned with stop-loss contract provisions, plan documents, eligibility requirements, and reimbursement terms.
Provide oversight of high-cost claimant identification, reimbursement submissions, recovery efforts, carrier communications, appeals, and operational compliance.
Manage carrier and stop-loss vendor relationships, including performance monitoring, audits, issue resolution, and operational effectiveness.
Develop operational reporting, performance metrics, dashboards, and quality initiatives to improve reimbursement recovery, service delivery, and operational efficiency.
Serve as the senior escalation point for complex reimbursement issues, contractual interpretations, audit findings, and client-impacting operational concerns.

Client Claim-Funding & Premium Administration

Direct operational processes supporting client claim funding, including funding calculations, cash calls, prefunding requirements, reconciliation activities, and exception management.
Ensure accurate and timely reconciliation of client funding, paid claims, stop-loss reimbursements, refunds, and outstanding balances in partnership with Finance and Claims.
Oversee premium-funding operations, including premium calculations, invoicing, collections, reconciliations, remittance coordination, and delinquency management.
Establish and maintain strong financial controls, reporting processes, audit trails, and documentation standards that support contractual, regulatory, and business requirements.
Monitor and communicate financial risks, unresolved variances, funding gaps, and operational exposures to leadership and key stakeholders.

People Leadership & Organizational Development

Lead, develop, and mentor managers and team members through effective coaching, performance management, goal setting, and professional development.
Build organizational capability through workforce planning, succession planning, cross-training, onboarding, and talent development initiatives.
Establish clear governance, service expectations, accountability measures, and escalation protocols across direct and cross-functional teams.
Foster a culture of collaboration, ownership, operational excellence, innovation, and continuous improvement.

Cross-Functional Partnership & Strategic Initiatives

Partner with Product, Claims, Clinical, Finance, Technology, Client Management, and Data teams to support operational readiness, process improvements, and new product capabilities.
Translate business and carrier requirements into scalable operational workflows, procedures, system enhancements, training materials, and reporting solutions.
Drive modernization and automation initiatives that improve efficiency, reduce risk, enhance reporting, and strengthen the client experience.
Support client-facing teams by providing operational expertise, reimbursement updates, issue resolution, and analytical insights.

Required Qualifications

Bachelor's degree in Business, Healthcare Administration, Finance, Insurance, or a related field, or an equivalent combination of education and experience.
10+ years of progressive leadership experience in stop-loss administration, self-funded health plans, claims operations, funding operations, or a related healthcare/insurance environment.
5+ years of experience leading managers and operational teams, including responsibility for employee development, performance management, workforce planning, and cross-functional collaboration.
Strong knowledge of stop-loss administration, reimbursement processes, policy and contract interpretation, high-dollar claims, and carrier requirements.
Proven ability to improve operational performance through process optimization, controls, automation, and risk management.
Exceptional analytical, problem-solving, communication, and stakeholder management skills, with the ability to influence decisions and lead through complexity.

Leadership Responsibilities

Lead, develop, and mentor managers and team members in a high-performing, service-oriented environment.
Establish clear goals, performance expectations, and accountability measures across the organization.
Drive workforce planning, succession planning, talent development, and organizational effectiveness initiatives.
Foster a culture of collaboration, continuous improvement, customer focus, and operational excellence.
Partner effectively with senior leadership and cross-functional teams to achieve strategic and operational objectives.

Why choose us?

We're a people-first company and value giving back to our community. Ask us about our volunteer opportunities.
Our space is a reflection of who we are-innovative, open and collaborative.
We think feeling your best is an important factor in producing great work, so we embrace a "smart casual" dress code and work at ergonomic desks.
Need to reenergize? When at our Westborough headquarters, take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.

Our Benefits Package

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life, including:

Medical, Dental and Vision and Prescription Drug Coverage
Fitness Reimbursement Benefit
Employee Assistance Program
Flexible Spending Account & Health Savings Account
401(k) and Quarterly Bonuses
Generous Paid-Time Off & Volunteering Opportunities
Educational Assistance & Professional Development Opportunities

So, think you want to join the HPI team? We hope to hear from you!

You can read more about us at hpitpa.com/about-us/careers/

Meridian Health Plan

1 Job Openings at Meridian Health Plan

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