Lead Director, Underwriting - Stop Loss & Large Claim Strategy

CVS Health • Hartford, OK

22h

About The Position

This role provides strategic leadership over medical underwriting and risk assessment for high-cost claimants, with a focus on protecting profitability while supporting membership growth and revenue objectives. The position oversees Large Claim Support functions, including identification, evaluation, and management of high-risk cases across a diverse book of business.

Requirements

• Bachelor’s degree or equivalent work experience.
• 10+ years of financial underwriting experience, including deep expertise in high-cost claimant risk.
• 10+ years of Stop Loss and/or medical underwriting experience.
• Demonstrated experience leading managers, individual contributors, and larger teams.
• Proven leadership capability with strong cross-functional partnership skills.

Nice To Haves

• Advanced knowledge of high-cost claimant management and Stop Loss product strategy.
• Broad understanding of other benefit programs (medical, dental, vision, pharmacy, Medicare, voluntary benefits) and their impact on risk assessment.
• Degree in Mathematics, Economics, Accounting, or a related field strongly preferred.

Responsibilities

• Lead and direct managers and multi-functional clinical underwriting teams responsible for complex, high-profile new business and renewal underwriting decisions.
• Oversee core Stop Loss Center of Excellence (COE) functions, including audits, tools, underwriting strategy, training, and continuous process improvement.
• Own reconciliation processes and provide oversight of the Cognizant support team to ensure accuracy, consistency, and operational efficiency.
• Anticipate and proactively address issues that materially impact financial performance, applying sound, unbiased decision-making.
• Oversee a broad book of business spanning all market segments and funding arrangements, including large claimant underwriting for Aetna Signature Administrators.
• Guide teams in the evaluation and management of high-cost claimant risk to optimize earnings and client outcomes.
• Support underwriting teams in resolving complex or escalated risk assessments.
• Lead multiple managers and professional teams to achieve Stop Loss COE goals through clear articulation of business strategy and underwriting best practices.
• Identify staffing needs and drive talent management activities, including hiring, performance management, succession planning, training, and professional development.
• Serve as a coach and mentor to managers and senior underwriters.
• Build and maintain strong cross-functional partnerships with Sales, Account Management, and other internal stakeholders.
• Represent the organization on internal work groups and external forums, acting as a subject-matter expert and thought leader.
• Effectively negotiate and resolve conflicts using clear, impactful oral and written communication.

Benefits

• Comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• CVS Health bonus, commission or short-term incentive program
• Equity award program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 5,001-10,000 employees