Meridian Health Plan

Senior Director, Stop Loss and Funding Ops

Meridian Health Plan • $130K — $180K *
Westborough, MA 01581Hybrid
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in Business, Healthcare Administration, Finance, Insurance, or related field.
  • 10+ years of progressive leadership experience in stop-loss administration or self-funded health plans.
  • 5+ years of experience leading managers and operational teams.
  • Strong knowledge of stop-loss administration and reimbursement processes.
  • Proven ability to improve operational performance through process optimization.

Responsibilities

  • Lead the administration of stop-loss programs, including implementation and policy management.
  • Ensure operational processes align with contract provisions and eligibility requirements.
  • Oversee high-cost claimant reimbursements and recovery efforts.
  • Manage relationships with carriers and stop-loss vendors for operational effectiveness.
  • Develop performance metrics and dashboards to enhance operational efficiency.

Benefits

  • Comprehensive medical, dental, and vision coverage.
  • Fitness reimbursement benefits.
  • Flexible spending accounts and health savings accounts.
  • 401(k) plan with quarterly bonuses.
  • Generous paid time off and volunteering opportunities.
Full Job Description
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/

About Meridian Health Plan

Meridian Health Plan Headquarters was a planned highrise in the Campus Martius district of downtown Detroit. The skyscraper would have had 16 stories with office space, ground level retail outlets, a state-of-the-art plaza, and a 9-story, 1,000 space parking deck. Detroit-based Meridian Health Plan would have been the sole office tenant in the 16-story building on the block bounded by Monroe, Bates and Farmer streets by Campus Martius Park. Meridian planned to occupy to 300,000 square feet of space in the $111 million development. Designs for the Class A building included first-floor retail space and a nine-story, 1,000-space parking deck. The brownfield incentives would be for site preparation and infrastructure improvements at the 1.96-acre site, a 230-space surface parking lot. Meridian, which has about 620 employees in two downtown offices in One Kennedy Square, 777 Woodward Ave., and the Dan Gilbert-owned 1001 Woodward building, would move into its new headquarters in early 2017, according to Sean Cotton, the company's general counsel. By that time, the company expects to have 1,050 employees in Detroit. Meridian initiated the new building project and hired Livonia-based Schostak Bros. as the developer. The site of the building is currently an oddly shaped, 230-space parking lot. Special architectural elements included a "floating box" like element, which is said to be the site of a restaurant. Other elements included a levitating belt of ivy, which will span from the 9-story parking deck, through the plaza, and to the side of the building. The main developer of the mid-rise was Schostak Bros. & Co. construction, which is located in the nearby suburb of Livonia.
Learn more about Meridian Health Plan
Size
501 employees
Market Cap
$1.3 billion
Industry
Finance & Insurance
Founded
1960
5 Year Trend
+15.4%
NASDAQ
EBSB
* Ladders Estimates

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