Senior Manager, Stop Loss Filling

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

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.

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.