Director, Stop Loss Operations

Job Description

Job Description

About Crumdale Specialty

Crumdale Specialty is a diversified insurance firm providing custom solutions to businesses nationwide. We leverage industry expertise, superior talent, and a disruptive mindset to deliver agile, transparent, and cost-saving solutions that optimize self-funded health plans. Our company culture is rooted in alignment, innovation, and integrity, and we are proud to be recognized as one of Inc. Magazine’s Best Places to Work.

Position Summary

The Director of Stop Loss Operations will serve as a strategic leader responsible for overseeing the administration of our stop loss business with a strong focus on the adjudication, analysis, and optimization of stop loss claims. This role will ensure accurate, timely, and compliant stop loss claims and policy administration processes while driving operational excellence. The Director will lead a team of analysts and collaborate cross-functionally with internal departments, external TPAs, external MGUs, and carrier partners to ensure best-in-class claims outcomes.

Key Responsibilities

Claims Oversight & Adjudication

• Oversee end-to-end Specific, Aggregate, and Level-Funded stop loss claims processing, ensuring compliance with policy provisions, regulatory standards, and Crumdale’s internal protocols
• Schedule, track, and review complex aggregate and level-funded claims and financial reconciliations for accuracy, eligibility, and reimbursement integrity
• Ensure timely adjudication and resolution of claims, including coordination with internal departments as well as TPAs, PBMs, audit vendors, carriers, and external MGU partners

Team Leadership & Development

Carrier & Vendor Collaboration

Compliance & Reporting

Requirements

Benefits

At Crumdale, we strive to provide a comprehensive and supportive benefits package to ensure the well-being of our employees. Our benefits include :

Please note : Crumdale Specialty is not engaging with external recruitment agencies; please refrain from contacting us regarding this position.